Visceral Leishmaniasis without Fever in an 11-Month-Old Infant: a Rare Clinical Feature of Kala-azar

Abstract

Visceral leishmaniasis or kala-azar is an endemic parasitic disease in some parts of the world which is characterized by fever, splenomegaly, and pancytopenia in most of the cases. Herein we report an 11 month-old male infant with diagnosis of kala-azar who presented with pallor, hepatosplenomegaly, failure to gain weight, and no history of fever. Surprisingly, fever started after beginning of meglumine antimoniate treatment in this patient. As far as we are aware of, this is a rare presentation of visceral leishmaniasis. Therefore, clinicians especially in endemic areas are highly recommended to include kala-azar among differential diagnosis of unexplained anemia without fever to prevent misdiagnosis of this potentially fatal, but treatable condition.

A case of visceral leishmaniasis found by left oblique hernia: A case report

“…VL is characterized by intermittent fever, hepatosplenomegaly, pancytopenia and polyclonal hyperimmune globulinemia. These symptoms are easily confused with AIDS, aplastic anemia, and plasma cell systemic diseases (7,8). The diagnosis of VL is based on the detection of Leishmania amastigotes in the human body (3,9).…”

T cell suppression in the bone marrow of visceral leishmaniasis patients: impact of parasite load

“…Demonstration of the amastigote form of Leishmania parasite in aspirates of lymph node, spleen or bone marrow is still the gold standard for diagnosis [4][5][6]; parasitic grading is usually used as per the World Health Organization (WHO) guidelines (0-6 1 ) of splenic aspirate [7]. The WHO grading system has also been used for bone marrow (BM) aspirate [8,9], even though the possibility of dilution by peripheral blood remains a concern. Severe parasitic infestation within the reticulo-endothelial system (RES), including visceral organs such as the liver, spleen and in the BM, is the pathological hallmark of the disease [10].…”

Comparison of hematological aspects: Visceral leishmaniasis and healthy children

“…In areas endemic for VL, the disease tends to have a chronic course, and children are especially affected. [ 6 7 8 9 ]…”