The clinical presentation of visceral leishmaniasis possesses a long incubation period (ranging from a few weeks to even years), a nonspecific symptomatology, and a variable clinical course, and may pose a diagnostic challenge [1] [2] [3] [4]. The two main signs of visceral leishmaniasis are fever and pancytopenia, both being almost universally present in all patients who suffer from this type of leishmaniasis [1] [2]. Fever can range anywhere between 37-40°C and often has an irregular pattern of occurrence [5]. On the other hand, pancytopenia (including thrombocytopenia, anemia, and leukopenia) causes weakness and severe immunosuppression, thus promoting various superinfections of bacterial, viral, or parasitic origin [1] [2] [5]. Opportunistic infections are, in fact, the leading cause of death from visceral leishmaniasis, with mortality rates being as high as 75%-95% in the absence of an early diagnosis and appropriate therapy [1]. The term "kala-azar" (meaning black death) is used to describe visceral leishmaniasis that is restricted to the Old World and caused by Leishmania donovani [1]. Wasting and poor general condition induced by pancytopenia are seen in advanced stages of the disease [6]. In addition to fever and bone marrow suppression, hepatosplenomegaly is another important sign in visceral leishmaniasis, seen in up to 85-100% of patients in some studies [5]. Lymphadenitis is a less frequent manifestation [2] [5].

• Splenomegaly

  Infantile VL may begin suddenly, with high fever and vomiting, or insidiously, with irregular daily fever, anorexia, and marked splenomegaly. [ncbi.nlm.nih.gov]

  It can be difficult to diagnose this disease in endemic settings as several causes of febrile splenomegaly exist, notably malaria. [bmj.com]

  The US also confirmed splenomegaly with diffuse hypoechoic lesions (Figure 2). Figure 2. Splenomegaly with diffuse innumerable hypoechoic foci. [acgcasereports.gi.org]

  Clinical symptoms include fever, weight loss, and splenomegaly; pancytopenia and hypergammaglobulinemia are often present. [mayomedicallaboratories.com]

• Massive Splenomegaly

  Visceral leishmaniasis (VL), i.e., infection with Leishmania sp. associated with high fever, weight loss, massive splenomegaly and markedly altered laboratory parameters, is generally fatal if untreated. [ncbi.nlm.nih.gov]

  There are very few pediatric conditions that can stimulate massive splenomegaly, as observed in our patient and reported in VL [ 20 ]. [ispub.com]

  splenomegaly Laboratory tests may show pancytopenia and hypergammaglobulinaemia Complications include gastrointestinal bleeding, peripheral oedema, acute renal failure and secondary bacterial infections Generalised hyperpigmentation is a late feature [dermnetnz.org]

  VL caused by all species has five characteristic hallmark features that include organomegaly (e.g., massive splenomegaly and moderate hepatomegaly), fever, cachexia and weight loss, pancytopenia and hypergammaglobulinemia. [pedinfect.com]

• Generalized Lymphadenopathy

  lymphadenopathy, profound weakness and a wasting syndrome [11▪▪,13,14]. [journals.lww.com]

  Clinical manifestations of VL include recurrent fever, hepatosplenomegaly, generalized lymphadenopathy, pancytopenia, and anemia. Death occurs in the absence of appropriate chemotherapy ( 4 ). [doi.org]

• Fever

  Fever can range anywhere between 37-40°C and often has an irregular pattern of occurrence. [symptoma.com]

  Herein we report an 11 month-old male infant with diagnosis of kala-azar who presented with pallor, hepatosplenomegaly, failure to gain weight, and no history of fever. [ncbi.nlm.nih.gov]

  Visceral leishmaniasis, also known as kala-azar, is characterized by irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anaemia (which may be serious). [who.int]

  FÖREDRAGEN TERM Leishmaniasis, Visceral HÄNVISNINGSTERMER Black Fever Fever, Black Kala Azar Kala-Azar ANMÄRKNING coordinate with NEGLECTED DISEASES if pertinent; do not confuse entry term BLACK FEVER with BLACKWATER FEVER or AMAZON BLACK FEVER see HEPATITIS [finto.fi]

• Asymptomatic

  Although unlikely to be exclusive for VL, these signatures can be useful to better characterize asymptomatic infections in endemic regions of this disease. [ncbi.nlm.nih.gov]

  Ag both in asymptomatic and symptomatic infection-derived PBMC ( Fig. 3A, 3B ). [jimmunol.org]

  […] gene study) and asymptomatic carriage. [clinicaltrials.gov]

• Anemia

  Infection is characterized by pancytopenia (anemia, thrombocytopenia, neutropenia), hepatosplenomegaly, fever, and severe immunosuppression that can lead to fatal opportunistic diseases without early recognition. [symptoma.com]

  A type of leishmaniasis occurring chiefly in India, caused by the protozoan parasite Leishmania donovani and characterized by fever, enlargement of the spleen and liver, progressive anemia and leukopenia, and weight loss. [medical-dictionary.thefreedictionary.com]

  […] ka·la-azar | \ ˌkä-lə-ə-ˈzär, ˌka- \ : a severe parasitic disease chiefly of tropical areas that is marked by fever, progressive anemia, leukopenia, and enlargement of the spleen and liver and caused by a leishmania ( Leishmania donovani ) transmitted [merriam-webster.com]

  Adverse events in the liposomal-therapy group were infusion-related fever or rigors (in 40%) and increased anemia or thrombocytopenia (in 2%); such events in the conventional-therapy group were fever or rigors (in 64%), increased anemia (in 19%), and [ncbi.nlm.nih.gov]

• Malaise

  […] funkcionalno nepismene, kot potrebe po izogibanju morebitnim stereotipom v zvezi s tem profilom ugotavljajo naslednje en Leishmaniasis sl Stari se bo zlomil, pa če bo tekla kri en Visceral leishmaniasis causes systemic disease, presenting with fever, malaise [sl.glosbe.com]

  English Visceral leishmaniasis causes systemic disease, presenting with fever, malaise, weight loss and anaemia, swelling of the spleen, liver and lymph nodes; most of the cases reported worldwide occur in Bangladesh, Brazil, India, Nepal and Sudan. [mymemory.translated.net]

  Common symptoms are fever, malaise, weight loss and anaemia, with swelling of the spleen, liver and lymph nodes in visceral human leishmaniasis. [ecdc.europa.eu]

  […] systemic disease characterized by darkening of the skin as well as the pentad of fever, weight loss, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia Viscerotropic leishmaniasis: Nonspecific abdominal tenderness; fever, rigors, fatigue, malaise [medscape.com]

• Chills

  We report the case of a 73-year-old American traveler who presented with 3 weeks of fatigue, fevers, chills, and pancytopenia. [ncbi.nlm.nih.gov]

  It is commonly characterized by fever, chills, vomiting, anemia, hepatosplenomegaly, leukopenia, hypergammaglobulinemia, emaciation, and an earth-gray color of the skin. [icd10data.com]

• Aspiration

  Ninety seven of the VL suspects were confirmed as cases by microscopy of lymph node aspirates. [ncbi.nlm.nih.gov]

  Fine needle aspiration cytology was performed on the left submandibular and axillary lymph nodes, which yielded thick aspirate. [cytojournal.com]

  Parasite demonstration in bone marrow/spleen/lymph node aspiration or in culture medium is the confirmatory diagnosis. However, sensitivity varies with the organ selected for aspiration. [nhp.gov.in]

  […] and blast), but also included most of the CD14 + monocytes present in the aspirate. [doi.org]

• Cough

  An 18-year-old immunocompetent patient was referred to a local hospital with submandibular lymphadenopathy, nonproductive cough, and occasional fever. [intjinfection.com]

  We present a case of a 12-year-old girl with a history of recurrent fever, anorexia, cachexia, chronic fatigue, weight loss, left palpebral unilateral edema, persistent cough and pancytopenia. [ncbi.nlm.nih.gov]

  Side-effects include abdominal pain, vomiting, nausea, fatigue, headache, increase of liver enzymes, nephrotoxicity, arthralgia, fever, rash, cough, pneumonia, pancytopenia and reversible peripheral neuropathy. [clinicalmicrobiologyandinfection.com]

• Respiratory Distress

  Other manifestations may dominate such as diarrheal attacks, respiratory distress, and seizures, especially in children. The signs and symptoms are unspecific and can be confused with other conditions. [intechopen.com]

• Abdominal Pain

  On the 13 th day of treatment, he presented with abdominal pain and vomiting. The biochemical, hematological, and radiological features were suggestive of acute pancreatitis. [ncbi.nlm.nih.gov]

  Sign In A 49-year-old man presented with fever, abdominal pain, and unintentional weight loss. He had an enlarged liver and spleen, and examination of a bone marrow aspirate revealed amastigotes. A diagnosis of visceral leishmaniasis was made. [nejm.org]

  pain and cramping, severe watery diarrhea, dehydration, flushing of the face, muscle cramps due to low potassium levels (hypokalemia), and weight loss.[1][2] When a person has a VIPoma and these associated symptoms, it is referred to as VIPoma syndrome [rarediseases.info.nih.gov]

• Loss of Appetite

  Visceral leishmaniasis can cause no or few symptoms but typically is associated with fever, loss of appetite (anorexia), fatigue, enlargement of the liver, spleen and nodes and suppression of the bone marrow. [medicinenet.com]

  In the first two weeks to two months an adult will generally exhibit a fever along with symptoms of fatigue, weakness, and loss of appetite. As the patient weakens the disease becomes worse. [microbewiki.kenyon.edu]

  Adults more often have bouts of fever, night sweats, tiredness and loss of appetite. There may also be abdominal discomfort, grey discoloration of the skin and weight loss. [news-medical.net]

  Visceral — affects organs of the abdominal cavity Severe weight loss Loss of appetite ( anorexia ) Diarrhea Tarry feces (less common) Vomiting Nose bleed Exercise intolerance Cutaneous — affects the skin Hyperkeratosis — most prominent finding; excessive [petmd.com]

• Abdominal Distension

  On general physical examination, the patient was found to be thin built, pale, and afebrile with abdominal distension. Left submandibular and left axillary lymph nodes were enlarged and measured 1.5 cm in diameter. [cytojournal.com]

  Fifty-seven percent of the patients had abdominal distension, and 49% had anorexia. Fever and splenomegaly were present in more than 95% of the patients. [pedinfect.com]

  distension, abdominal pain, vomiting, nausea, bleeding tendency, paleness, jaundice, lymph node enlargement, palpable spleen and palpable liver, only a few weakly significant differences appeared. [doi.org]

• Hepatosplenomegaly

  Infection is characterized by pancytopenia (anemia, thrombocytopenia, neutropenia), hepatosplenomegaly, fever, and severe immunosuppression that can lead to fatal opportunistic diseases without early recognition. [symptoma.com]

  VL should be considered in the differential diagnosis in returning travellers presenting with prolonged fever, hepatosplenomegaly and/or pancytopenia. [ncbi.nlm.nih.gov]

• Hepatomegaly

  The features of VL may be different in immunosuppressed patients, with more fever and less hepatomegaly and leukopenia than in HIV-infected patients. [ncbi.nlm.nih.gov]

  After assessing the course of symptoms and their progression during the interview, a meticulous physical examination, particularly abdominal palpation, will reveal either hepatomegaly, splenomegaly, or both. [symptoma.com]

• Liver Fibrosis

  The differential diagnosis includes liver fibrosis, abnormal blood flow due to splenic vein thrombosis or portal vein obstruction, and liver cirrhosis due to chronic viral hepatitis B or C, fatty liver, and alcohol use. [acgcasereports.gi.org]

• Erythema

  Board review question #1 The most common symptom of a VIPoma is Abdominal pain Acromegaly Diarrhea Necrotizing migratory erythema Weakness Board review question #2 VIPomas are most likely to arise in the Body of the pancreas Duodenum Head of the pancreas [pathologyoutlines.com]

  (V. brazilliensis) Involves nose ,mouth, larynx Unusual nasal symptoms- epistaxis, edema, erythema of nasal mucosa Nodules like CL, Inside nose- perforation nasal septum ,enlarged lips&nose ,larynx-voice change 19. [slideshare.net]

  The objective examination of the patient demonstrated generalized erythema of the body accompanied by numerous scaling elements [Figure 1] and focal purulent erosive lesions, located mainly in hands and feet [Figure 2]. [actamedicainternational.com]

• Skin Plaque

  There is a primary lesion which spreads to involve multiple areas of the skin. Plaques, ulcers and nodules may form over the entire body. [patient.info]

• Arthralgia

  Side-effects include abdominal pain, vomiting, nausea, fatigue, headache, increase of liver enzymes, nephrotoxicity, arthralgia, fever, rash, cough, pneumonia, pancytopenia and reversible peripheral neuropathy. [clinicalmicrobiologyandinfection.com]

  […] well as the pentad of fever, weight loss, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia Viscerotropic leishmaniasis: Nonspecific abdominal tenderness; fever, rigors, fatigue, malaise, nonproductive cough, intermittent diarrhea, headache, arthralgias [medscape.com]

  Arthralgia and myalgia and elevated hepatic and pancreatic enzymes are other common adverse events. Antimonials are more toxic in HIV patients, and a significant proportion of them has chemical pancreatitis. [journals.lww.com]

  Chemical pancreatitis, nausea and abdominal pain, arthralgia and fatigue are common. ECG changes may occur. [patient.info]

• Suggestibility

  The CD8+ clones mediated increased levels of IL-10 secretion in the presence of PBMC alone suggesting that CD8+ T cells may mediate endogenous IL-10 secretion. [ncbi.nlm.nih.gov]

• Neglect

  Valenzuela, Visceral Leishmaniasis and HIV Coinfection in Latin America, PLoS Neglected Tropical Diseases, 8, 9, (e3136), (2014). [doi.org]

  […] tools for neglected diseases: mathematical models in economic evaluations Turner HC, Walker M, French MD, Blake IM, Churcher TS, Basáñez MG. [ntdmodelling.org]

  In 2012, the WHO Roadmap on neglected tropical diseases targeted regional elimination of visceral leishmaniasis by 2020. [who.int]

  This is even more crucial in neglected diseases, for which the arsenal of drugs is limited. [itg.be]

  Loading metrics Open Access Neglected Diseases Neglected Diseases PLOS Medicine's Neglected Diseases section began with the launch of the journal in October 2004. [journals.plos.org]

• Asthenia

  After acute debut with fever, dyspepsia, asthenia, patient subjected conventional treatment for such situations. Because of the lack of the well outcome she underwent sternal punction. [ibn.idsi.md]

  The initial signs include persistent or intermittent fever, diarrhea, asthenia, adynamia, nonproductive cough, somnolence, and progressive weight loss. [omicsonline.org]

  Clinical manifestations Number of patients % Hepatomegaly 633 98.0 Splenomegaly 632 97.8 Fever 628 97.7 Pallor 533 82.5 Increased lymph nodes 500 77.5 Increased abdominal volume 463 71.7 Weight loss 462 71.5 Long eyelashes 454 70.3 Dry hair 450 69.7 Asthenia [intechopen.com]

A detailed patient history and a thorough physical examination are the first and perhaps crucial steps for making an initial diagnosis of visceral leishmaniasis. The vast majority of patients (> 90%) who suffer from visceral leishmaniasis come from six countries of the world: India, Bangladesh, Sudan, South Sudan, Ethiopia, and Brazil [6] [7] [8]. For this reason, the physician should conduct a detailed patient history that will cover recent travel to endemic countries, as well as possible exposure to sand flies in the last few years. After assessing the course of symptoms and their progression during the interview, a meticulous physical examination, particularly abdominal palpation, will reveal either hepatomegaly, splenomegaly, or both. In order to solidify the diagnosis, laboratory and microbiological tests need to be conducted. A basic complete blood count (CBC) is sufficient to detect pancytopenia, while directed diagnostic testing for Leishmania is broadly divided into indirect and direct methods. Serological testing (specifically enzyme-linked immunosorbent assay, or ELISA, and fluorescence antibody testing) is widely used as the main indirect test that has good sensitivity/specificity [1] [2] [3] [4]. Detection of antigen rk39 through ELISA is a very reliable procedure and is used by many laboratories over the world [3] Conversely, identification of the parasite by light microscopy and Giemsa staining from blood samples is a relatively easy and effective procedure, while lymph node, liver, spleen, or even bone marrow samples might be used for evaluation, but the risks of bleeding (particularly in the case of spleen and bone marrow) often outweigh the benefit of confirming the diagnosis histologically [1] [2] [3] [4].

• Neutropenia

  Infection is characterized by pancytopenia (anemia, thrombocytopenia, neutropenia), hepatosplenomegaly, fever, and severe immunosuppression that can lead to fatal opportunistic diseases without early recognition. [symptoma.com]

  Abnormal results of laboratory investigation were severe hypochromic anemia, leukopenia with neutropenia, thrombocytopenia, increased C-reactive protein levels, and positive results of a direct Coombs' test (Table). [jamanetwork.com]

  Hepatosplenomegaly Ascites and edema Pancytopenia Possible darkened or gray skin color (especially on the palms and soles) Immunosuppression may lead to secondary bacterial infections in advanced disease Diagnostics Laboratory tests Hemolytic anemia Neutropenia [amboss.com]

  Recombinant human granulocyte-macrophage stimulating factor has been found to be effective in reversing neutropenia and reducing secondary infection in kala azar [21]. Kala azar and HIV Infection Kala azar can occur at any stage of HIV infection. [ncbi.nlm.nih.gov]

  Granulocyte and macrophage colony stimulating factors – G-CSF and GM-CSF – have been used in the treatment of hematological disorders in patients with VL and neutropenia. [omicsonline.org]

• Hyperglobulinemia

  In active VL, macrophages host the replicating amastigotes in phagolysosomal compartments leading to splenomegaly, hepatomegaly, hyperglobulinemia, anemia, weight-loss, incessant fever and ultimately death if not treated. [books.google.com]

  The most consistent serum biochemistry findings in dogs with clinical canine leishmaniosis are serum hyperproteinemia with hyperglobulinemia and hypoalbuminemia, frequently expressed by a decreased albumin:globulin ratio. [msdvetmanual.com]

  Serum biochemistry revealed hyperproteinemia 100.0 g/L [54.0 – 82.0 g/L], hyperglobulinemia 83.0 g/L [23.0 – 52.0 g/L] and hypoalbuminemia 18.0 g/L [25.0 – 44.0 g/L]. [parasitesandvectors.biomedcentral.com]

• Hyperglobulinemia

  In active VL, macrophages host the replicating amastigotes in phagolysosomal compartments leading to splenomegaly, hepatomegaly, hyperglobulinemia, anemia, weight-loss, incessant fever and ultimately death if not treated. [books.google.com]

  The most consistent serum biochemistry findings in dogs with clinical canine leishmaniosis are serum hyperproteinemia with hyperglobulinemia and hypoalbuminemia, frequently expressed by a decreased albumin:globulin ratio. [msdvetmanual.com]

  Serum biochemistry revealed hyperproteinemia 100.0 g/L [54.0 – 82.0 g/L], hyperglobulinemia 83.0 g/L [23.0 – 52.0 g/L] and hypoalbuminemia 18.0 g/L [25.0 – 44.0 g/L]. [parasitesandvectors.biomedcentral.com]

• Zinc Increased

  Human behaviour, such as sleeping outside or on the ground, may increase risk. Malnutrition Diets lacking protein-energy, iron, vitamin A and zinc increase the risk that an infection will progress to a full-blown disease. [who.int]

  Malnutrition: diets lacking protein energy, iron, vitamin A and zinc increase the risk that infection will progress to kala azar. Poor housing, including sleeping outside on the ground. (Insecticide-treated bed nets reduce risk.) [patient.info]

• Liver Biopsy

  The gold standard for diagnosis is a bone marrow or liver biopsy to detect amastigotes (any organ that is involved may be used). A splenic puncture could also be done since it is more productive, but it can result in severe bleeding. [web.stanford.edu]

  Liver biopsy and lymph node dissection may also provide material. Various serological tests are available, but most cutaneous cases do not develop a significant antibody response. [patient.info]

  Given the possibility of metastatic disease, we recommended that she undergo a liver biopsy, but she declined. Surgical resection can offer immediate improvement in symptoms and may increase survival. [mdmag.com]

  […] there is the risk of rupture or bleeding. 12 Liver biopsy is safer, although finding amastigotes is certain only in very heavy infections. 11, 12 Bone marrow aspiration (from the sternum) is frequently used, 11 but it is a specialized technique with [dovepress.com]

  Rostan et al. reported that the serum IL-33 levels were higher in VL patients besides the presence of IL33+ cells in liver biopsy of a patient. [frontiersin.org]

Research Treatment of Indian... [bmj.com]

[…] variables, serum chemistry, body weight, and the size of the spleen and liver every week during treatment, at the end of treatment, and at 6 months after the treatment ended. [nejm.org]

Liposomal amphotericin B is FDA-approved for treatment of visceral leishmaniasis and generally is the treatment of choice for U.S. patients. [cdc.gov]

Your doctor may recommend other treatments based on the type of leishmaniasis you have. Cutaneous leishmaniasis Cutaneous ulcers will often heal without treatment. [healthline.com]

Visceral leishmaniasis, associated with HIV/AIDS coinfection, is becoming a more aggressive disease, complicating an accurate prognosis. [ncbi.nlm.nih.gov]

References:[3][6][7] Leishmaniasis Summary Epidemiology Etiology Cutaneous leishmaniasis Clinical features Diagnostics Treatment Prognosis Visceral leishmaniasis Clinical features Diagnostics Treatment [amboss.com]

Prognosis Prognosis is highly variable and is dependent on many factors. In those with benign, surgically resectable tumors, the reported 5-year survival rate is almost 95%. [orpha.net]

Some researchers have noted that patients with jaundice had worse prognosis [21]. [intechopen.com]

Treatment and prognosis Acute management includes fluid and electrolyte replacement, as well as symptomatic management of diarrhea with agents such as octreotide which inhibit VIP secretion 4. [radiopaedia.org]

However, a strong clinical suspicion compelled further evaluation by polymerase chain reaction (PCR), which validated the etiology. This short report highlights the usefulness of PCR in diagnosing cases of suspected smear-negative VL recurrence. [ncbi.nlm.nih.gov]

All the common etiologies were excluded in our patient, but her travel history triggered an extended work-up to investigate parasitic etiologies such as Leishmania, which are otherwise unusual to the United States. [acgcasereports.gi.org]

References:[3][6][7] Leishmaniasis Summary Epidemiology Etiology Cutaneous leishmaniasis Clinical features Diagnostics Treatment Prognosis Visceral leishmaniasis Clinical features Diagnostics Treatment [amboss.com]

/epidemiology* DNA, Intergenic/genetics DNA, Protozoan/blood DNA, Protozoan/genetics Enzyme-Linked Immunosorbent Assay Female HIV Infections/complications HIV Infections/epidemiology* Humans Iran/epidemiology Leishmania infantum/immunology Leishmania [ncbi.nlm.nih.gov]

Ref: WHO/CTD/LEISH/98.23 Leishmania/HIV co-infection - Epidemiological analysis of 692 retrospective cases. [who.int]

This phenomenon has its origins in environmental [ 19 ] and epidemiological [ 5 ] alterations. [omicsonline.org]

Describe the cause of visceral leishmaniasis, the way it is transmitted and the basic epidemiology of the disease. [lshtm.ac.uk]

Useful For Suggests clinical disorders or settings where the test may be helpful Diagnosis of active visceral leishmaniasis Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Visceral [mayomedicallaboratories.com]

Knowledge gaps were identified in relation to pathophysiology, risk factors, and the role of PKDL patients in transmission. [dndi.org]

This two-page spread overviews the pathophysiology of visceral leishmaniasis—also known as Kala Azar, or black fever. [inessaskaya.com]

Verner–Morrison syndrome and WDHA syndrome (watery diarrhea, hypokalemia, achlorhydria) (Rom J Morphol Embryol 2017;58:371) ICD coding ICD-10: C7A.8 - other malignant neuroendocrine tumors ICD-10: E16.8 - other specified disorders of pancreatic internal secretion Pathophysiology [pathologyoutlines.com]

Pathophysiology and Etiology VIP has a molecular weight of 3381, consists of 28 amino acids, and belongs to the secretin-glucagon family. The VIP gene is located on chromosome 6. [emedicine.medscape.com]

One is liposomal amphotericin B (AmBisome) and the other is an antimonial compound called pentostam. [2] Prevention There is no vaccines available to prevent people from visceral leishmaniasis It is important for people to avoid outdoor activities, especially [microbewiki.kenyon.edu]

PREVENTION No vaccines or drugs to prevent infection are available. [wwwnc.cdc.gov]

Key strategies for prevention are listed below: Early diagnosis and effective prompt treatment reduces the prevalence of the disease and prevents disabilities and death. [who.int]

The only way to prevent leishmaniasis is to avoid getting bitten by a sand fly. Follow these steps to help prevent being bitten by a sand fly: Wear clothing that covers as much skin as possible. [healthline.com]

[…] and Prevention, Zhengzhou 450016, China [jsczz.cn]

1. Ready PD. Epidemiology of visceral leishmaniasis. Clin Epidemiol. 2014;6:147-154.
2. Barrett MP, Croft SL. Management of trypanosomiasis and leishmaniasis. Br Med Bull. 2012;104:175–196.
3. Srivastava P, Dayama A, Mehrotra S, Sundar S. Diagnosis of visceral leishmaniasis. Trans R Soc Trop Med Hyg. 2011;105(1):1-6.
4. Sassi A, Louzir H, Ben Salah A, Mokni M, Ben Osman A, Dellagi K. Leishmanin skin test lymphoproliferative responses and cytokine production after symptomatic or asymptomatic Leishmania major infection in Tunisia. Clin Exp Immunol. 1999;116:127–132.
5. Harizanov RN, Kaftandjiev IT, Jordanova DP, Marinova IB, Tsvetkova ND. Clinical features, diagnostic tools, and treatment regimens for visceral leishmaniasis in Bulgaria. Pathog Glob Health. 2013;107(5):260-266.
6. Singh OP, Sundar S. Developments in Diagnosis of Visceral Leishmaniasis in the Elimination Era. J Parasitol Res. 2015;2015:239469.
7. Gawade S, Nanaware M, Gokhale R, Adhav P. Visceral leishmaniasis: A case report. Australas Med J. 2012;5(2):130-134.
8. Alvar J, Vélez ID, Bern C, et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS ONE. 2012;7(5)