Visceral leishmaniasis in Sudan. Clinical features.

Kala azar is a disease endemic to the Sudan and a cause of major morbidity and mortality to affected patients when the diagnosis or treatment has been delayed. In this report we described the clinical features of 99 parasite proven patients with visceral leishmaniasis. The Sudanese kala azar patient is young in age (teens to 20's), has marked weight loss despite a continuous, excellent appetite and suffers from insomnia, epistaxis and abdominal pain. Hepatosplenomegaly is universally present. Generalized lymphadenopathy is a prominent feature (72%). The high prevalence of lymphadenopathy has a wide range of implications: for diagnosis, i.e., the use of lymph node aspiration; for response to treatment, i.e., the resolution of lymphadenopathy; and for studies of immunoregulation in this systemic infection.

Visceral leishmaniasis in the Sudan: comparative parasitological methods of diagnosis.

Patients with suspected kala-azar had aspirations of spleen, lymph node and bone marrow performed to compare the relative merit of each procedure. Splenic aspiration remains the method most likely to provide microscopic proof of leishmanial infection (18 of 19 samples) and was the only site positive in 5 patients. Lymph node aspirates contained parasites in 20 of 29 patients, whereas bone marrow aspirates provided the diagnosis in 18 of 28. Therefore, lymph node aspiration, with its minimal morbidity, is indicated as the primary diagnostic method in patients in the Sudan with suspected kala-azar. If negative, splenic aspiration should be performed.