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 Leishmaniasis

Visceral (Kala-azar="Black Sickness")

• Spread by sandflies
• Large animal reservoir
• Blood spread to many tissues
• male 3:1 female
• associated with HIV

Organisms

• Leishmania donovani
• Leishmania chagasi
• Leishmania infantum

Course

• protozoa spread from site of minor skin lesions
• organisms multiply in macrophages

Presentation

• Fevers
• Splenomegaly
• weight loss
• sweats
• fatigue
• reduced appetite
• rigors
• cough
• hepatomegaly
• burning feet
• insomnia
• abdominal pain
• arthralgia
• epistaxis
• enlarged lymph nodes

Diagnosis

• Microscopy of bone marrow, spleen/lymph nodes
• Serology

Investigations

• FBC = hypersplenism
  • anaemia
  • thrombocytopenia
  • reduced WCC
• Albumin reduced
• Increased IgG
• -ve Leishmanin skin test
•  

Treatment

• Stibogluconate (antimonial)
• Allopurinol
• Pentamidine
• Liposomal amphotericin B (expensive)