Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

892 Leishmaniasis, Visceral

Signs & Symptoms

■Spectrum from asymptomatic to severely ill. Gradual onset, 2–6

months after bite(s), of fever, weight loss, gradual enlargement of

liver and spleen, pallor, sometimes darkening of skin. Exam shows

pallor, weight loss, enlarged lymph nodes, enlarged liver and spleen,

sometimes mucosal ulcerations.

tests

■Basic tests: blood: CBC shows anemia, neutropenia. LFTs show mild

transaminase elevations, low albumin, high globulin (polyclonal

increase in IGG).

■Basic tests: urine: albuminuria sometimes seen.

■Specific tests: Bone marrow aspirate for amastigotes. Splenic punc-

ture for amastigotes (should be done only by experienced person-

nel). Serologic tests helpful but vary in accuracy and subject to some

cross-reactions. Most helpful in screening patient as an FUO. ELISA

and IFA are preferred tests (done by the CDC).

■Other tests: none helpful

differential diagnosis

■Malaria, brucellosis, tuberculosis, endocarditis, hematologic and

lymphatic malignancies, disseminated histoplasmosis, tropical sp-

lenomegaly

management

What to Do First

■Nutritious diet, look for and treat any complicating infection, trans-

fuse if needed.

General Measures

■Assess renal function, EKG, pancreatic enzymes, in preparation for

treatment.

specific therapy

Indications

■Any symptomatic patient

Treatment Options

■Sodium stibogluconate for 28 days, occasionally longer

■Liposomal amphotericin B (considered drug of choice by some but

very expensive)