A 31-year-old woman returned 3 months ago from a long holiday in the Middle East and North Africa, where she traveled widely and slept in a tent or cheap hotels. 

She gives a 2-week history of fever, anorexia, and abdominal discomfort. She has taken malaria prophylaxis. 

There is no history of diarrhea or constipation. 

On examination, she is pale but not jaundiced. There is no lymphadenopathy, but the spleen is palpable 8 cm below the left costal margin, and the liver is also clinically enlarged. 

- Hemoglobin (Hb) 93 g/L 

- White blood cells (WBC) 3.4 X 109/L (lymphocytes 40%, neutrophils 55%) 

- Platelets 74 X 109/L 

- Normal Urea and electrolytes 

- Normal Liver function tests 

- Negative Stool, blood, urine, and throat saliva culture. 

- A liver biopsy was performed. 

 

Q3. What is the recommended therapy? 

A1. The bone marrow aspirate shows Leishman–Donovan bodies within a macrophage, and the diagnosis is visceral leishmaniasis (kala-azar). 

Her mild pancytopenia is due to splenic enlargement, though a mild leukopenia can also occur as part of the disease. 

A2. Infection with Leishmania Donovani, which is a protozoan, is transmitted by the bite of sandflies, typically from an animal (e.g., dog) reservoir. 

While in the Indian form of the disease the humans are the reservoir. Hepatosplenomegaly, sometimes with lymphopenia, is typically seen.

Hypergammaglobulinemia, notably a polyclonal increase in IgM, and a correspondingly raised erythrocyte sedimentation rate (ESR) are other noteworthy features. 

The peripheral blood film showed circulating, reactive plasma cells and rouleaux. 

Leishman–Donovan bodies are also noted in the bone marrow aspirate. 

A3. Pentavalent antimonials, for example, sodium stibogluconate, are the drugs of choice.