Assessment of Visceral Leishmaniasis Consequences Using Ultrasound

Abstract

Background and Aim: Visceral leishmaniasis (VL), also known as kala azar, is a parasitic disease that caused by infection with Leishmania parasites, which are spread by the bite of phlebotomine sand flies. An ultrasound examination is strongly advocated for the promote diagnosis and treatment of VL for long term follow up and evaluation of unresponsive cases. The aim of this study was to assess the consequences of VL in the liver, spleen and pancreas of affected participants by using ultrasound. Materials and Methods: A prospective cohort study was conducted in the period of January 2012 to March 2014 in the ultrasound department of Tropical Disease Hospital (TDH) in Khartoum-Sudan, among a group of 100 participants (84% males, 16% females and their ages ranges from 15 to 45 years) positive to VL and had been diagnosed by laboratory tests; either serological or Napier's Aldehyde test. The Aloka portable ultrasound machine equipped with 3.5 MHz convex probe was used for abdominal ultrasound scanning. Standard Statistical Package for the Social Sciences (SPSS) was used to analyze the results. Results: The commonest ultrasound findings in VL participants were hepatomegaly (100%), splenomegaly (100%) and ascites (50%). Other complications such as lymphadenopathy (35%), focal splenic lesions (34%), dilated portal vein (7%) and shrinkage liver (4%) were detected. Conclusion: Ultrasound scanning presents an effective role in VL, because of its ability to detect the consequences of this disease in various abdominal organs such as liver, spleen and pancreas earlier, which in turn allowing the possibility to treat these complications and prevents the deterioration of a patient's health status.

Abdominal ultrasound in the diagnostic work-up of visceral leishmaniasis and for detection of complications of spleen aspiration

“…These were uncommon in VL patients in our study, and the frequency was not different in non-VL patients. Similarly, abdominal lymphadenopathy was infrequent in our study, but present in 35–90% of the VL cases in Sudan [ 11 ]. The reason for these differences is currently unclear.…”

“…Another study, also from Sudan, described focal splenic lesions in 34% of 50 VL patients [ 12 ]. Multiple nodular hypo- or hyperechogenic lesions with or without halo have also been found previously in sporadic case reports [ 8 , 11 , 13 , 14 ]. However, none of these studies included a control group; hence the diagnostic accuracy of US for VL diagnosis remains undefined to date.…”

“…The frequent detection of ascites and pleural effusion in our study is in line with findings from Sudan, as well as the detection of abnormal echotexture in kidneys, liver and spleen. Splenic focal lesions in VL were commonly reported from Sudan, occurring in 34% [ 11 ]. These were uncommon in VL patients in our study, and the frequency was not different in non-VL patients.…”

“…In several case reports, VL was characterized by focal [ 7 – 9 ] or granulomatous lesions in the spleen and/or liver [ 10 ] which could be visualised by US, CT scan or MRI. In a study in 2014 that included 50 Sudanese VL patients hepatosplenomegaly, ascites and intra-abdominal lymphadenopathy were reported as common abdominal US findings [ 11 ]. Another study, also from Sudan, described focal splenic lesions in 34% of 50 VL patients [ 12 ].…”

Point-of-Care Ultrasound Assessment of Tropical Infectious Diseases—A Review of Applications and Perspectives

“…US consistently reveals hepatosplenomegaly, and, in a large proportion of cases, abdominal lymphadenopathy. 79,80 In recent reports, nodular changes in the spleen have been reported, particularly in children 81 but also in adults. 82 Whether these US findings, which could be incorporated into a POCUS protocol, could help with the diagnosis or follow-up of VL and/or with the differential diagnosis between TB and VL in coendemic areas, remains to be studied.…”