Diagnosis
Old world Leishmaniasis that disseminates to bone marrow, spleen and liver. Presents with fever, weight loss, hepatosplenomegaly, anemia, and leukopenia.
Look for parasites on splenic or bone marrow aspirate. There is also various serologic tests.
Epidemiologic Risks
Sand fly bite in India, Mideast, Asia and N. Africa.
Microbiology
L. donovani that disseminates to bone marrow, spleen and liver.
Empiric Therapy
In order of preferred treatment: stibogluconate sodium 20 mg/kg /day for 20 to 28 days, liposomal Amphotericin B, ketoconazole 400 - 600 mg qd and itraconazole have activity against some Leishmania. The ins and outs of leishmania are too complicated for this rough guide.
Oral Miltefosine is highly effective.
Pearls
AKA black fever and Dumdum fever.
Always call the CDC for help when treating this disease.
Last Update: 10/23/18.