Leishmaniasis

Alternative names:

kala-azar

Symptoms:

• history of exposure to the bite of sandflies
• history in being in an area known for leishmaniasis

Systemic illness (visceral leishmaniasis)

• fever, persistent, long duration (weeks), may cycle irregularly
• fatigue
• weakness
• appetite loss (anorexia)
• abdominal discomfort, vague
• vomiting (children)
• diarrhea (children)
• cough (children)
• skin, scaly
• skin, gray, dark, ashen
• hair, thinning

Skin disease (cutaneous leishmaniasis)
skin:

• macule or papule, erythematous
• skin ulcer, forms at site of original lesion
• ulcer heals very slowly over a matter of months
• smaller lesions may form around the ulcer (satellite lesions)

mucous membranes:

• nasal stuffiness
• runny nose (coryza)
• nosebleed (epistaxis)
• ulcers and erosion of tissue (mouth, tongue, gums, lips, nose, nasal septum
• swallowing difficulty (dysphagia) with esophageal involvement
• breathing difficulty, with tracheal involvement

Signs and tests:

• enlarged spleen
• enlarged liver (less common than enlarged spleen)
• enlarged lymph nodes (less common than enlarged spleen)

Tests:
Systemic disease:

• skin test, called the Montenegro skin test
• skin biopsy
• biopsy of the spleen (demonstrates the host phase of the parasite, called amastigote)
• bone marrow biopsy (demonstrates the host phase of the parasite, called amastigote)
• lymph node biopsy (demonstrates the host phase of the parasite, called amastigote)
• culture of biopsy material (demonstrates the vector phase of the parasite, called promastigote)
• indirect immunofluorescent antibody test
• direct agglutination assay

Other tests (complementary to the diagnosis)

• CBC (shows decreased cellularity of blood, pancytopenia)
• hemoglobin (shows signs of anemia)
• serum protein (decreased)
• serum albumin (decreased)
• immunoglobulins (increased)