Visceral Leishmaniasis (Kala Azar); Presentation, Diagnosis and Response to Therapy (An Experience of Ten Cases in Adults)

Abstract

Background: Visceral Leishmaniasis is not uncommon in the NWFP and Afghanistan. Samarbagh and Timergera being the areas of NWFP adjoining Afghanistan has the distinction that both cutaneous and visceral leishmaniasis present early to the physicians. Cutaneous Leishmaniasis is usually easy to diagnose. Visceral Leishmaniasis on the other hand present usually with a diagnostic dilemma. Mostly the cases present in the paediatric age group but some present in adolescents and adults. We are presenting a study of ten such patients in the adult population.

Objectives: To study the different modes of presentation of Visceral Leishmaniasis in adult population, the methods of diagnosis and the response to therapy with Arsenic compounds.

Setting: Tehsil Headquarter Hospital, Samarbagh and District Headquarter Hospital, Timergera.

Methods: A prospective cases of ten cases of Visceral Leishmaniasis in the adult population. The age range varied between 15 years and 35 years. Six patients were males and four were females.

Results: The commonest presenting symptoms were fever, mass in the abdomen, anorexia, generalized fatigue and malaise. The common signs were organomegaly and fever. Laboratory diagnosis confirmed Leishman Danovan bodies in the bone marrow smear of all patients. There was also pancytopenia in eight patients. Two patients had anaemia without pancytopenia. Meglumine antimonate (glucantime) is the only drug available for Visceral Leishmaniasis, is very effective and all of these patients responded to the standard therapy with no relapse at six month’s followup.

Conclusion: The physician should have a high suspicion of Visceral Leishmaniasis in patients presenting with fever and organomegaly, usually of long standing, with no response to the conventional treatment, worsening of symptoms and mostly negative laboratory investigations or anaemia and pancytopenia which is gradually worsening from an endemic area. It is an easily treatable condition and once the sinister diagnosis of lymphoma and leukaemia are excluded by bone marrow smear examination and a positive diagnosis done, it is amenable to therapy with antimonials.