No abstract

A case of visceral leishmaniasis in a young American Peace Corps volunteer is reported. Both clinical and epidemiologic evidence strongly supported the diagnosis; however, hepatic and splenic aspirates for the causative organism were negative. The diagnosis was eventually confirmed through serology, employing indirect immunofluorescence and complement fixation testing of serum. The patient clinically responded dramatically to sodium stibogluconate, the drug of choice for the treatment of visceral leishmaniasis. This case is significant because it alerts the physician to an unusual cause of fever of unknown origin in residents of the Western nations and demonstrates the potential usefulness of serology in diagnosing visceral leishmaniasis when the infecting organism cannot be isolated. Visceral leishmaniasis (kala-azar), caused by the protozoan Leishinaifla donovani, is a predominantly Third World and tropical disease. Thus, travel history is important in making the proper diagnosis in residents of the United States. The definitive diagnosis is traditionally established by isolation of the amastigote form of L. donovanil from aspiration of the liver, spleen, or bone marrow (3. 11).