Diagnosing visceral leishmaniasis
BMJ 2023; 383 doi: https://doi.org/10.1136/bmj-2023-076715 (Published 16 October 2023) Cite this as: BMJ 2023;383:e076715Linked Clinical Update
Managing visceral leishmaniasis
- Nitin Bansal, consultant1,
- Ankur Jain, assistant professor2
- 1Infectious Diseases, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi-110085, India
- 2Clinical Haematology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi-110029, India
- Correspondence to: A Jain drankur589{at}yahoo.in
What you need to know
Visceral leishmaniasis can cause prolonged fever, massive splenomegaly, peripheral cytopenias, diffuse cutaneous hyperpigmentation, and, if untreated, death in people with a history of residence in, or travel from an endemic area
Low cost immunochromatographic serological tests are available and can assist in rapid diagnosis in resource limited settings.
A man in his 60s who resides in Bihar in eastern India, presented to a district hospital with a one month history of fever (maximum oral temperature of 101°F (38°C)). Examination revealed mild skin pallor and moderate splenomegaly. Routine blood work-up showed pancytopenia and elevated globulin levels, and rapid immunochromatographic strip test (testing for antibodies against rK39 antigen) was positive. Bone marrow aspirate (performed because leishmaniasis was suspected) showed numerous intracellular Leishman-Donovan bodies (amastigotes).
Visceral leishmaniasis (also known as kala-azar) is one of 20 neglected tropical diseases listed by the World Health Organization1 and can be fatal if left undiagnosed and untreated.23 In this article, we summarise the diagnosis strategies used in different endemic regions, the principles of which can also be applied in non-endemic regions—for example, when travellers returning from endemic regions present with symptoms suggestive of visceral leishmaniasis. We cover management of visceral leishmaniasis in a separate article.4
What is visceral leishmaniasis?
Visceral leishmaniasis is the systemic manifestation of leishmaniasis, a parasitic disease spread through the bite of the female phlebotomine sand fly.23 In India, Bangladesh, Sudan, Ethiopia, Kenya, and Somalia, visceral leishmaniasis is primarily caused by Leishmania donovani.56 In other regions, including Spain, France, Greece, the Middle East, Afghanistan, Iran, Pakistan, and Brazil, visceral leishmaniasis is caused by L infantum (also known as L chagasi in Latin America).56 In India, Nepal, and Bangladesh humans are the main reservoir of infection. In some other endemic countries infected dogs and rodents might also be …
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