Supportive managements

In circumstances where patients are severely sick from additional infections, severely anemic, dehydrated and with organ dysfunctions, it may be important to delay administration of antileishmania drugs until patients are stabilized. However, it should not be delayed by days as VL is fatal unless treated.

Hydration: Most of the VL patients present with dehydration as a result of the high grade fever, vomiting, diarrhea and poor intake. The physical signs of dehydration (sunken eye balls, shrunken skin, poor skin turgor) overlap with signs of malnutrition commonly seen in VL patients. The blood pressure and pulse volume should be checked meticulously. Serum creatinine level may rise as a result of pre-renal azotemia. Hypotensive patients and patients with elevated creatinine require intravenous normal saline resuscitation. Patients should be encouraged to take more fluid especially during the febrile period.  Fever usually subsides after five days of antileishmania treatment.

Nutrition: Moderate to severe malnutrition is common with VL. As study in northwest Ethiopia among 403 adult VL patients showed 67% moderate to severe malnutrition. Among under five children with VL 22% were having wasting. Malnutrition has its own consequences for recovery during treatment. Nutritional rehabilitation is important. Patients have to be supplemented with balanced diet. Micronutrient and multivitamin supplementation are needed.

Anemia: Anemia recovers with the treatment of VL. However, if severe and patient is in congestive heart failure, edematous malnutrition and sepsis, transfusion has to be considered.

Bleeding: Epistaxis is the most common bleeding. It may be self-limiting and often improve with VL treatment. Petechie, purpura or ecchymosis and other extensive bleedings can occur. Bleeding is mainly due to thrombocytopenia. Such patients need fresh blood transfusion, and if there are signs of moist bleedings (oral, retinal, subconjuctival) platelet transfusion is needed.