Visceral Leishmaniasis - Diagnosis and Management Summary

Species: Leishmania donovani, Leishmania infantum, Leishmania chagasi

Where: South Asia, East Africa, mediterranean, Middle East and Latin America

Pathogenesis: Leishmania invade and replicate within macrophages → Evades innate and cell-mediated immune responses → Neutralization of complement components, Prevent release of superoxide and NO, Suppress induction of antigen-specific CD4+ T helper

Presentation: 

 • Incubation period 2-6 months

 • Fever, Lymphadenopathy, Malaise, Abdominal Pain, Spontaneous abortion, Weight Loss

 • Can cause Hemophagocytic Lymphohistiocytosis

 • Anemia, Neutropenia, Thrombocytopenia

 • ↑LFTs, ↑Bilirubin, ↑BUN/Cr, ↑Hypergammaglobulinemia

Diagnosis: Bone marrow aspiration (histopathology, culture, PCR, K39)

Treatment:

 1) Liposomal Amphotericin B: 3 mg/kg on days 1-5, 14, and 21 for a total of 21 mg/kg

 2) Miltefosine 50 mg PO tid 28 days

 3) Sodium stibogluconate 20 mg/kg/d IV/IM 28-30 days



By @TheIDtrivia



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