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Mohammed R, Gebrewold Y, Schuster A, Fikre H, Mekonnen T, Mulaw T, Bogale T, Vogt F, Diro E, van Griensven J. Abdominal ultrasound in the diagnostic work-up of visceral leishmaniasis and for detection of complications of spleen aspiration. PLoS Negl Trop Dis 2021; 15:e0009107. [PMID: 33592024 PMCID: PMC7935305 DOI: 10.1371/journal.pntd.0009107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 03/05/2021] [Accepted: 01/05/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Abdominal ultrasound (US) is increasingly used in the diagnostic work-up of infectious diseases, but studies on its diagnostic value in visceral leishmaniasis (VL) are lacking. US could help to identify complications of spleen aspiration (SA). We aimed to assess the diagnostic value of US and the evolution of findings after VL treatment; the incidence and degree of splenic injury; and the pain perceived during SA. Methodology/result We conducted a cross-sectional prospective study at the Leishmaniasis Research and Treatment Center, Gondar, Ethiopia between Oct 2017 and Dec 2018. We enrolled VL suspects undergoing tissue aspiration; US were conducted before and after SA, and at the end of VL treatment. Splenic injury was graded using the American association of surgery trauma injury scale (grade 1–4). The pain perceived during SA was graded using a visual analogue scale. Out of 392 VL suspects, 192 (49%) were confirmed VL cases. The median age was 25 years (IQR 21–30). Massive splenomegaly and hepatomegaly were the most common US findings. Splenic nodules were seen in 3.7% of the 190 VL cases and 1.5% of the 197 non-VL cases. Ascites was more common in VL (16.4%) than in non-VL cases (9.1%). The frequency of US abnormalities decreased with treatment. None of the US findings had sufficient sensitivity and specificity to justify its use as a diagnostic test. US detected splenic injury in four of the 318 patients who had post-SA US. All four patients remained clinically stable. Pain was perceived as moderate or severe in 51% of patients. Conclusion The diagnostic value of abdominal US for VL was low but found useful to detect subclinical splenic injury. SA caries a risk of splenic injury and was perceived painful by most. Further research on less invasive diagnostic tools is needed. Diagnostic value of abdominal US for visceral leishmaniasis in Ethiopian setting is limited. US finding of patients decreased in frequency with VL treatment. US detects iatrogenic subclinical splenic injury trough splenic aspiration in VL suspects. Iatrogenic splenic injury occurred in 1.3%of all blinded splenic aspirations done in VL suspected patients. 51% of VL suspects described moderate to severe pain (score ≥ 5 on visual analogue scale) after splenic aspiration.
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Affiliation(s)
- Rezika Mohammed
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
- Leishmanisis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | | | - Angela Schuster
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Helina Fikre
- Leishmanisis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Tigist Mekonnen
- Leishmanisis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Tadele Mulaw
- Leishmanisis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Tadfe Bogale
- Leishmanisis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Florian Vogt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Bélard S, Stratta E, Zhao A, Ritmeijer K, Moretó-Planas L, Fentress M, Nadimpalli A, Grobusch MP, Heller T, Heuvelings CC. Sonographic findings in visceral leishmaniasis - A narrative review. Travel Med Infect Dis 2020; 39:101924. [PMID: 33227498 DOI: 10.1016/j.tmaid.2020.101924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Visceral leishmaniasis (VL) is predominantly a neglected tropical parasitic disease but may also be acquired by travellers. We aimed at summarizing knowledge on sonographic presentation of VL to better understand sonographic features of VL. METHODS PubMed was searched for studies and case reports presenting original data on sonographic findings of VL, published before August 13th, 2019. Demographic, clinical, and sonographic data were extracted and summarized in a qualitative approach. RESULTS A total of 36 publications were included in this review; 27 of these were case reports and the remainder were prospective or retrospective studies. No study reported systematic cross-sectional comparative imaging. Overall, publications reported on 512 patients with VL of whom 12 were reported HIV-infected. Spleno- and hepatomegaly were the most frequently reported findings. Further relevant and repeatedly reported findings were splenic and hepatic lesions, abdominal lymphadenopathy, pleural and pericardial effusion and ascites. Reported focal splenic lesions were heterogeneous in size, shape, and echogenicity. Several publications reported gradual diminution and resolution of sonographic findings with VL treatment. CONCLUSION Available literature on sonographic findings of VL is limited. Available reports indicate that spleno- and hepatomegaly, free fluid, abdominal lymphadenopathy, and focal splenic lesions may be common sonographic features in patients with VL. Because of the apparent overlap of sonographic features of VL, extrapulmonary tuberculosis and other conditions, interpretation of sonographic findings needs to be made with particular caution.
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Affiliation(s)
- Sabine Bélard
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Erin Stratta
- Médecins Sans Frontières, 40 Rector St., 16th Floor, New York, NY, 10006, USA.
| | - Amelia Zhao
- Médecins Sans Frontières, 40 Rector St., 16th Floor, New York, NY, 10006, USA.
| | - Koert Ritmeijer
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, the Netherlands.
| | - Laura Moretó-Planas
- Médecins Sans Frontières, Medical Department, Carrer Zamora 54, Barcelona, 08005, Spain.
| | - Matthew Fentress
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK; Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA; University of California, Davis, 4860 Y St., Suite 2300, Sacramento, CA 95817, USA.
| | - Adi Nadimpalli
- Médecins Sans Frontières, 40 Rector St., 16th Floor, New York, NY, 10006, USA.
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD, Amsterdam, the Netherlands.
| | - Tom Heller
- Lighthouse Clinic, Kamuzu Central Hospital, Kamuzu Central Hospital Area 33 Mzimba Street, P.O. Box 106, Lilongwe, Malawi.
| | - Charlotte C Heuvelings
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD, Amsterdam, the Netherlands.
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Diro E, van Griensven J, Mohammed R, Colebunders R, Asefa M, Hailu A, Lynen L. Atypical manifestations of visceral leishmaniasis in patients with HIV in north Ethiopia: a gap in guidelines for the management of opportunistic infections in resource poor settings. THE LANCET. INFECTIOUS DISEASES 2014; 15:122-9. [PMID: 25300862 DOI: 10.1016/s1473-3099(14)70833-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In regions where it is endemic, visceral leishmaniasis is an important opportunistic infectious disease in people living with HIV. Typically, clinical presentation of visceral leishmaniasis includes chronic fever, hepatosplenomegaly, and weight loss. In Leishmania infantum endemic regions in Europe, atypical visceral leishmaniasis presentations have been well documented, with almost every possible organ involved. However, such reports are rare in Leishmania donovani endemic regions such as east Africa. In this Personal View, we describe the various atypical disease presentations in patients screened as part of an HIV and visceral leishmaniasis clinical trial in north Ethiopia, where up to 40% of patients with visceral leishmaniasis are co-infected with HIV. Atypical presentations such as these are not covered in clinical guidelines used in these settings. Apart from the lack of diagnostic facilities, this gap contributes to the underdiagnosis of atypical visceral leishmaniasis, with associated morbidity and mortality. Involvement of clinicians experienced with the management of HIV and visceral leishmaniasis co-infection in the development of HIV clinical guidelines in affected regions is warranted.
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Affiliation(s)
- Ermias Diro
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia.
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, University Hospital Antwerp, Belgium
| | - Rezika Mohammed
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Robert Colebunders
- Department of Clinical Sciences, Institute of Tropical Medicine, University Hospital Antwerp, Belgium
| | - Mesfin Asefa
- Department of Pathology, University of Gondar, Gondar, Ethiopia
| | - Asrat Hailu
- Department of Microbiology, Parasitology and Immunology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, University Hospital Antwerp, Belgium
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