Working Paper Case Report Version 1 This version is not peer-reviewed

Skin Maculae, Chronic Diarrhea, Cachexia and Splenomegaly – Late Presentation of the First Autochthonous Case of Visceral Leishmaniasis in Tanzania

Version 1 : Received: 20 October 2020 / Approved: 22 October 2020 / Online: 22 October 2020 (09:30:22 CEST)

How to cite: Henke, O.; Mapendo, P.J.; Mremi, A.; Mmbaga, L.G.; Pallangyo, A.; Harbaum, T.; Mkwizu, E.W. Skin Maculae, Chronic Diarrhea, Cachexia and Splenomegaly – Late Presentation of the First Autochthonous Case of Visceral Leishmaniasis in Tanzania. Preprints 2020, 2020100451 Henke, O.; Mapendo, P.J.; Mremi, A.; Mmbaga, L.G.; Pallangyo, A.; Harbaum, T.; Mkwizu, E.W. Skin Maculae, Chronic Diarrhea, Cachexia and Splenomegaly – Late Presentation of the First Autochthonous Case of Visceral Leishmaniasis in Tanzania. Preprints 2020, 2020100451

Abstract

Presentation of case: A 20 year old men from Simanjiro district in northern Tanzania presented with a 3 year history of splenomegaly, fatigue, cachexia, skin maculae and recent onset of watery diarrhea at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Due to laboratory findings of pancytopenia, diagnostic workup included bone marrow aspiration cytology and biopsy. Although the rapid test (IT LEISH, rK39 RDT) was negative, blood smear showed amastigote forms of Leishmaniasis in macrophages. Repeat bone marrow aspiration and PCR eventually confirmed VL. The patient denied travel to known endemic areas of visceral leishmaniasis (VL). Treatment was initiated with Amphotericin B, but the patient died on the fourth day of treatment from respiratory insufficiency. An autopsy revealed massive organ manifestations of VL. Case discussion: This is the first reported autochthonous case of VL in Tanzania. Clark et al. detected the vector Phlebotomous martini in Northern Tanzania in 2013, in a region boardering the district of our patient. The negative rapid test draws attention to the fact that sensitivity and specificity was found to be low in East African VL patients as displayed earlier by a Kenyan study. Therefore, tissue samples (spleen or bone marrow) remain necessary for diagnosis. The variety of symptoms in this presented case was remarkable, including the occurrence of Post Kala Azar Dermal Leishmaniasis (PKDL) and VL at the same time. This has been described in East African VL cases before as well as the occurrence of chronic diarrhea. An elongated undiagnosed period likely led to a mixed clinical picture that included: hepato-splenomegaly, PKDL, cachexia, and diarrhea.

Subject Areas

visceral leishmaniasis; Kala Azar; Tanzania; East Africa

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