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*hepatosplenomegaly
*anemia
*many patients are asymptomatic and cured spontaneously
**cell-mediated immunity
*50,000-90,000 new cases reported per year 2004-2008
*202,200-389,100 new cases estimated per year 2004-2008 - underreporting
*''L. infantum'' (formerly ''L. chagasi'' was thought separated species)
**Mediterranean, China, South America
**dog , cattle is reservoir
====diagnosis of visceral leishmania====
*suspect for >2 weeks fever+splenomegaly with geographical relation*detection of amastigote in smear of bone marrow aspiration, lymph node or spleen aspiration
**sensitivity 93-99% in spleen aspirate, 53-86% in bone marrow aspirate, 53-65% in lymph node aspirate
***0.1% of life-threatening hemorrhage by spleen aspiration
*culture in NNN media
*immunochromatographical detection of rk39 antigen
**dip stick form
**97-100% sensitivity in Asia, low in Africa
***reason unkown, possibly the difference of subspecies
**cannot distinguish between active or relapse
**unkown sensitivity in HIV co-infection
*in areas of high HIV prevelence all leischmeniasis patients should be screened for HIV
*PCR
*importance of accurate diagnosis
**clinical features of VL resemble
====post kala-azar dermal leishmanisis (PKDL)====
