Skin maculae, chronic diarrhea, cachexia, and splenomegaly-Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania.
A 20-year-old man 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, diagno...
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ftdoajarticles:oai:doaj.org/article:9c2aa5568ecc4cfa94fc858f33adb02f 2023-05-15T15:13:12+02:00 Skin maculae, chronic diarrhea, cachexia, and splenomegaly-Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania. Oliver Henke Priscus John Mapendo Alex Mremi Lilian Gasper Mmbaga Angela Elisha Pallangyo Thomas Harbaum Elifuraha Mkwizu 2021-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0008925 https://doaj.org/article/9c2aa5568ecc4cfa94fc858f33adb02f EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0008925 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008925 https://doaj.org/article/9c2aa5568ecc4cfa94fc858f33adb02f PLoS Neglected Tropical Diseases, Vol 15, Iss 1, p e0008925 (2021) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2021 ftdoajarticles https://doi.org/10.1371/journal.pntd.0008925 2022-12-31T09:15:21Z A 20-year-old man 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 visceral leishmaniasis (VL). The patient denied travel to known endemic areas of 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. This is the first reported autochthonous case of VL in Tanzania. Clark and colleagues detected the vector Phlebotomus martini in Northern Tanzania in 2013, in a region bordering the district of our patient. The negative rapid test draws attention to the fact that sensitivity and specificity were 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. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Azar ENVELOPE(-63.733,-63.733,-64.983,-64.983) PLOS Neglected Tropical Diseases 15 1 e0008925 |
institution |
Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Oliver Henke Priscus John Mapendo Alex Mremi Lilian Gasper Mmbaga Angela Elisha Pallangyo Thomas Harbaum Elifuraha Mkwizu Skin maculae, chronic diarrhea, cachexia, and splenomegaly-Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
A 20-year-old man 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 visceral leishmaniasis (VL). The patient denied travel to known endemic areas of 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. This is the first reported autochthonous case of VL in Tanzania. Clark and colleagues detected the vector Phlebotomus martini in Northern Tanzania in 2013, in a region bordering the district of our patient. The negative rapid test draws attention to the fact that sensitivity and specificity were 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. |
format |
Article in Journal/Newspaper |
author |
Oliver Henke Priscus John Mapendo Alex Mremi Lilian Gasper Mmbaga Angela Elisha Pallangyo Thomas Harbaum Elifuraha Mkwizu |
author_facet |
Oliver Henke Priscus John Mapendo Alex Mremi Lilian Gasper Mmbaga Angela Elisha Pallangyo Thomas Harbaum Elifuraha Mkwizu |
author_sort |
Oliver Henke |
title |
Skin maculae, chronic diarrhea, cachexia, and splenomegaly-Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania. |
title_short |
Skin maculae, chronic diarrhea, cachexia, and splenomegaly-Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania. |
title_full |
Skin maculae, chronic diarrhea, cachexia, and splenomegaly-Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania. |
title_fullStr |
Skin maculae, chronic diarrhea, cachexia, and splenomegaly-Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania. |
title_full_unstemmed |
Skin maculae, chronic diarrhea, cachexia, and splenomegaly-Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania. |
title_sort |
skin maculae, chronic diarrhea, cachexia, and splenomegaly-late presentation of the first autochthonous case of visceral leishmaniasis in tanzania. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2021 |
url |
https://doi.org/10.1371/journal.pntd.0008925 https://doaj.org/article/9c2aa5568ecc4cfa94fc858f33adb02f |
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ENVELOPE(-63.733,-63.733,-64.983,-64.983) |
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Arctic Azar |
geographic_facet |
Arctic Azar |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 15, Iss 1, p e0008925 (2021) |
op_relation |
https://doi.org/10.1371/journal.pntd.0008925 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008925 https://doaj.org/article/9c2aa5568ecc4cfa94fc858f33adb02f |
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https://doi.org/10.1371/journal.pntd.0008925 |
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PLOS Neglected Tropical Diseases |
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15 |
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