Visceral Leishmaniasis: A Hidden Killer?

Leishmaniases are parasitic diseases caused by protozoan flagellates of the genus Leishmania, parasites infecting numerous mammal species, including humans. This is transmitted through the infective bite of an insect vector, the phlebotomine sandfly.

The leishmaniases are threatening 350 million people in 88 countries of four continents. In Sri Lanka too, cutaneous manifestation of leishmaniasis has been reported particularly in North Central Province.

Visceral leishmaniasis is a disease of the mononuclear phagocytic system, commonly affecting the spleen, liver, lymph nodes and bone marrow. However, other organs (intestine, lung) and skin may also become involved. In advanced cases, as in immune suppressed patients all organs are involved.

This case revealed a death of a 47 year old deceased male who was presented to the hospital with an upper abdominal pain for eight days and ultra sound examination revealed splenomegaly. Additional information indicated he had had on and off abdominal pain for one year, and the investigations revealed low haemoglobin, neutropenia with no features of malignancy and screening for haemoglobinopathy was suggested.

At the autopsy massive splenomegaly, hepatomegaly and ascites were observed and sections from all organs were taken for histology, which revealed Leishmania donovani bodies in Kupffer cells with dense perivascular infiltrate of lymphocytes and plasma cells. Spleen too, showed the sinuses that contain macrophages with LD bodies.

Conclusion: This case demonstrates visceral leishmaniasis as the cause of death and this is the first autopsy case where such a cause of death was encountered in Sri Lanka and reinforces the need of awareness of leishmaniasis.

Medico-Legal Journal of Sri Lanka 2013; 1(2) : 37-41