Bacterial Infection as a Presenting Manifestation of Visceral Leishmaniasis

Twopatients admitted to the hospital because of severebacterial infection werediagnosed as having visceral leishmaniasis. The types of bacterial infection were perianal abscess and pneumonia; Escherichia coli and Streptococcus pneumoniae were isolated from exu-dates and blood cultures, respectively. A third patient admitted because of acute necrotiz-ing infection of the pharynx and visceral leishmaniasis is also discussed. Cultures from this patient failed to yield pathogens. Anemia, leukopenia, or thrombocytopenia waspresent in all patients, and bone marrow aspirate revealed the presence of Leishmania in macro-phages. We conclude that in areas where leishmaniasis is endemic, early bone marrow aspirate should, in most instances, be performed in patients with bacterial infection as-sociated with anemia, leukopenia, or thrombocytopenia if hepatomegaly and/or spleno-megaly is present. Visceral leishmaniasis is a chronic disease caused by Leishmania donovani and is characterized by general malaise with fever, splenomegaly, polyclonal hypergammaglobulinemia, and hematologic distur