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Visceral leishmaniasis — Clinical Guidelines

Overview

Visceral leishmaniasis (VL) is a neglected tropical disease caused primarily by Leishmania infantum, characterized by prolonged fever, weight loss, and hepatosplenomegaly, with significant public health implications 1.

Diagnosis

Microscopy: Examination of stained tissue samples (e.g., bone marrow, spleen, or lymph nodes) for amastigotes 1.

Serological Assays: Include ELISA and DAT, though prone to low sensitivity and cross-reactivity 1.

Molecular Methods: PCR can enhance diagnostic accuracy but is not universally available 1.

Multi-epitope Antigens: Emerging diagnostic tools showing promise for improved sensitivity and specificity 1.

Management

First-line Treatment: Amphotericin B (typically 1 mg/kg/day for 10-15 days) and Miltefosine (oral, 50-100 mg/kg/day for 28 days) are commonly used 6.

Adjunctive Therapies: Supportive care including fluid management, electrolyte correction, and treatment of complications like secondary infections 8.

Monitoring: Regular follow-up to assess treatment efficacy and manage potential drug side effects 6.

Special Populations

Pediatrics: Specific dosing and monitoring guidelines are crucial due to potential differences in drug metabolism and tolerance 8.

Comorbidities: Patients with comorbidities may require tailored treatment plans to manage additional health risks 8.

Key Recommendations

Utilize multi-epitope antigens for enhanced diagnostic accuracy in visceral leishmaniasis (Evidence: Moderate 1).

Employ Amphotericin B or Miltefosine as first-line treatments, considering patient-specific factors like age and comorbidities (Evidence: Strong 6 8).

Implement rigorous monitoring and supportive care to address multisystem organ failure risks, especially in severe cases (Evidence: Moderate 8).

References

1 Baneshi M, Sadeghi M, Hashemi S, Alcedo C, Muro A, Manzano-Román R et al.. Design of a novel multi epitope antigen for diagnosis of visceral leishmaniasis using an immunoinformatics approach. Scientific reports 2025. link 2 Bhowmik D, Bhuyan A, Gunalan S, Kothandan G, Kumar D. (no title). Journal of biomolecular structure & dynamics 2024. link 3 Mittermair C, Weiss HG. Analogies between medusa and single port surgery in gastroenterology and hepatology: A review. World journal of gastroenterology 2021. link 4 Sinagra E, Buscaglia F, Giganti A, Bono V, Di Grusa D, Sciumè C. A very rare cause of retroperitoneal bleeding in young patients: do not forget the occurrence of a ruptured left gastroepiploic artery aneurysm!. Il Giornale di chirurgia 2019. link 5 Madhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P, Srivastava DN. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials. Korean journal of radiology 2016. link 6 Kshirsagar N, Ferner R, Figueroa BA, Ghalib H, Lazdin J. Pharmacovigilance methods in public health programmes: the example of miltefosine and visceral leishmaniasis. Transactions of the Royal Society of Tropical Medicine and Hygiene 2011. link 7 Yamagami T, Osuga K, Yoshimatsu R, Matsumoto T, Miura H, Terayama K et al.. Development of a portable training tool for simulating visceral angiographic procedures for beginners. Cardiovascular and interventional radiology 2009. link 8 Malatesha G, Mathur P, Madan K, Samanta P, Samantaray JC. Profile of fatal visceral leishmaniasis at an Indian tertiary care center. Tropical gastroenterology : official journal of the Digestive Diseases Foundation 2007. link 9 Nogueira FS, Moreira MA, Borja-Cabrera GP, Santos FN, Menz I, Parra LE et al.. Leishmune vaccine blocks the transmission of canine visceral leishmaniasis: absence of Leishmania parasites in blood, skin and lymph nodes of vaccinated exposed dogs. Vaccine 2005. link 10 Maher MM, Kealey S, McNamara A, O'Laoide R, Gibney RG, Malone DE. Management of visceral interventional radiology catheters: a troubleshooting guide for interventional radiologists. Radiographics : a review publication of the Radiological Society of North America, Inc 2002. link 11 Becker R, Gatscher S, Sure U, Bertalanffy H. The punctate midline myelotomy concept for visceral cancer pain control--case report and review of the literature. Acta neurochirurgica. Supplement 2002. link 12 Firdousi FH, Sharma D, Raina VK. Palliation by coeliac plexus block for upper abdominal visceral cancer pain. Tropical doctor 2002. link 13 Hirshberg RM, Al-Chaer ED, Lawand NB, Westlund KN, Willis WD. Is there a pathway in the posterior funiculus that signals visceral pain?. Pain 1996. link03127-2) 14 Miampamba M, Chéry-Croze S, Gorry F, Berger F, Chayvialle JA. Inflammation of the colonic wall induced by formalin as a model of acute visceral pain. Pain 1994. link90008-6) 15 Bekaert ED, Dole E, Dubois DY, Bouma ME, Lontie JF, Kallel R et al.. Alterations in lipoprotein density classes in infantile visceral leishmaniasis: presence of apolipoprotein SAA. European journal of clinical investigation 1992. link

Visceral leishmaniasis