Visceral Leishmaniasis

After 5 weeks of undulating fever, weight loss, and night sweats, a 22-year-old man presented to the emergency department. He reported no significant medical history. The patient had recently completed a course of tetracycline followed by another of azithromycin for a presumed upper respiratory tract infection.

Except for splenomegaly and fever, physical findings were normal. Pancytopenia was found on laboratory test results, which were otherwise normal. Radiologic studies were unremarkable. The differential included bacterial and/or viral infection, toxin exposure, paroxysmal nocturnal hemoglobinuria, and adverse reaction to antibiotic therapy.

Dr Kurt Demel of Christ Hospital, Cincinnati, writes that aspirate from a bone marrow biopsy revealed intracellular and extracellular microorganisms with eosinophilic-stained kinetoplasts that suggested Leishmania species (A and B, arrow). Antibody studies performed at the CDC confirmed the presence of high titers (1:512) of Leishmania infantum.

The patient had traveled to southern Italy 2 years earlier. L infantum is endemic to the Mediterranean coast and other regions.

Worldwide, 2 million new cases of leishmaniasis occur each year.¹ The parasitic disease presents with various clinical manifestations that range from skin eruptions and mucosal ulcers-seen in the cutaneous form of the infection-to overwhelming visceral disease, which is fatal if not treated.

This patient's symptoms resolved following a 3-week regimen of liposomal amphotericin B, 3 mg/kg/d.

REFERENCE:1. World Health Organization. Programme for the surveillance and control of leishmaniasis. Geneva: WHO; 2002. Available at: http://www.who.int/emc/diseases/leish/index.html. Accessed July 16, 2002.