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Visceral leishmaniasis

Key sources
The following summarized guidelines for the evaluation and management of visceral leishmaniasis are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA/ASTMH 2017).
1

Guidelines

1.Diagnostic investigations

Laboratory testing: use multiple diagnostic approaches to maximize the likelihood of a positive Leishmania result, using methods such as:
visualization of the characteristic amastigote in smears or tissue (histopathology)
parasite isolation by culture
molecular detection of parasite DNA
serologic testing
B
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  • Skin testing

2.Diagnostic procedures

Biopsy
Collect tissue aspirates or biopsy specimens for smears, histopathology, parasite culture, and molecular testing.
B
Perform bone marrow aspiration as the preferred first source of a diagnostic sample. Consider using liver, enlarged lymph nodes, and whole blood (buffy coat) as other potential sources of tissue specimens.
B

3.Medical management

Indications for treatment: treat patients with clinical abnormalities compatible with visceral leishmaniasis and laboratory evidence of visceral leishmaniasis.
B
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  • Amphotericin B

  • Miltefosine

  • Pentavalent antimony

4.Specific circumstances

Patients with human immunodeficiency virus/acquired immunodeficiency syndrome: offer liposomal amphotericin B for the treatment of visceral leishmaniasis in immunocompromised patients in North America.
B
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  • Patients with other causes of immunosuppression

5.Follow-up and surveillance

Monitoring of treatment response
Use clinical parameters to monitor the response to treatment, as they correlate well with parasitologic responses to treatment for visceral leishmaniasis.
B
Do not obtain parasitologic confirmation of response, such as by repeat bone marrow aspiration for microscopy and culture after treatment, in patients showing timely clinical response. Be aware that antibody levels fall but over many months or longer.
D

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  • Management of treatment failure

  • Management of relapse