Visceral leishmaniasis is a parasitic disease transmitted by sandflies, with 0.5 million new cases annually.1 It is most commonly seen in India, Bangladesh, Brazil, Sudan, and around the Mediterranean. About two cases are seen each year in the United Kingdom, and these usually originate from around the Mediterranean.2

Patients with visceral leishmaniasis present with fever, splenomegaly, and weight loss. It can be difficult to diagnose this disease in endemic settings as several causes of febrile splenomegaly exist, notably malaria. In this week's BMJ, a meta-analysis by Chappuis and colleagues compares the diagnostic performance of two serological tests in endemic settings, the direct agglutination test (DAT) and rK39 dipstick test.3 Outside endemic areas visceral leishmaniasis is often only considered after haematological malignancies have been excluded.2

In immunocompetent people visceral leishmaniasis can be treated with a 28 day course of a pentavalent antimonial, and the cure rate is 90-95%.4 In resource rich settings patients are treated with six to 10 days of liposomal amphotericin (an antifungal agent), and the cure rate is higher at 95-98%.4 …