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Clinical manifestations

Learning objectives

At the end of this session trainees are expected to:

  • Describe the clinical and lab manifestations of visceral leishmaniasis

Recommended facilitation strategy

  • First ask participants to jot down clinical manifestations they observed in their experience systematically
  • Let them read through and match their experience with what is listed here

The incubation period of VL is wide ranging from weeks to years; however, typically it is 2-6 months. Patients experience insidious onset fever, weight loss, abdominal swelling as a result of organomegaly. Soft splenomegaly is prominent. It has risk of rupture with easy trauma. Hepatomegally is less common. Lymphadenopathy is common in Sudan; it is rarely seen among patients from the other endemic regions.

As the disease progresses, the skin gets darker. The bone marrow gets suppressed and patients develop anemia, leukopenia and thrombocytopenia. This manifests with congestive heart failure, superinfections and bleeding tendencies. Hypoalbuminemia results from the malnutrition and liver dysfunction. Patients will become cachexic and edematous. Ascitic, jaundice, petechial rash occur.

Commonly seen superinfections include fungal skin infections, otitis media, pneumonia and diarrheal diseases. Patients may complicate with sepsis from these infections.

The laboratory findings in VL reflect the clinical manifestations mentioned above and the severity of the disease. Pancytopenia, hypoalbuminemia, hypergammaglobulinemia. Depending on severity of disease and complications elevation in transaminases, bilirubin and creatinine may be seen. 

Summary of clinical manifestations
Symptoms Signs Lab findings

Weight loss
Abdominal swelling
Easy bleeding
Leg swelling

Edema, ascites

Low hemoglobin
Low white blood cell count
Low platelet count
Elevated transaminases, bilirubin and creatinine

Diro E et al, Clinical aspects of pediatric visceral leishmaniasis in North-west Ethiopia, TMIH, 2014
Mengistu G and Ayele B, Visceral leishmaniasis and HIV co-infection in Patients admitted to Gondar University Hospital, Northwest Ethiopia, Ethio J Heath Dev. 2007; 21 (1): 53-60.
Hurissa Z et al, Clinical characteristics and treatment outcomes of patients with visceral leishmaniasis and HIV co-infection in northwest Ethiopia, Vol 15, No 7, 2010


Which other diseases have similar manifestations as visceral leishmaniasis?