Visceral leishmaniasis:

Visceral leishmaniasis 

Visceral leishmaniasis, the most severe form of leishmaniasis also known as kala-azar, is a life-threatening disease caused by Leishmania parasites which are transmitted by female sandflies. Visceral leishmaniasis causes fever, weight loss, spleen and liver enlargement, and, if not treated, death. People with both visceral leishmaniasis and HIV are particularly difficult to cure. The disease is also linked to environmental changes such as deforestation, building of dams, irrigation schemes, and urbanization.

Cause

Visceral leishmaniasis is caused by: 

• Leishmania parasites are transmitted through the bites of infected female phlebotomine sandflies 
• Poor housing and domestic sanitary conditions may increase sandfly breeding and resting sites. 
• Malnutrition increases the risk that an infection will progress to full-blown disease

Symptoms 

The sign and symptoms include:

• Fever
• Weight loss (cachexia; wasting)
• Hepatosplenomegaly (usually, the spleen is more prominent than the liver)
• Pancytopenia, i.e., anemia, leukopenia, and thrombocytopenia
• A high total protein level and a low albumin level, with hypergammaglobulinemia

Diagnosis

Clinical: high clinical suspicion of disease is given to people from endemic areas with a persistent disease and unexplained fever accompanied by suggestive signs and symptoms. 

Laboratory: immunological and parasitological tests are performed.

The immunological test currently available at the primary level is the rapid immunochromatographic test based on recombinant rK39 antigen, but the indirect immunofluorescence (IIF) and enzyme immunoassay (ELISA) is also used in other levels of care. Parasitological tests are performed by detecting parasites in infected tissues, mainly in the bone marrow, through direct examination or isolation in culture (in vitro). Molecular tests detect Leishmania DNA through the PCR method.

Note 1: Continue a 100 percent evaluation beyond the cessation of treatment for active disease. Six months after discontinuance of such treatment, determine the appropriate disability rating by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.  Thereafter, rate under the appropriate body system any residual disability of infection, which includes, but is not limited to liver damage and bone marrow disease.

Note 2: Confirm the recurrence of active infection by culture, histopathology, or other diagnostic laboratory testing.