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 #Visceral #Leishmaniasis #diagnosis #management #treatment #infectiousdiseases #microbiology
