**Author details**

The clinical picture of VL may also be consistent with that of malaria, typhoid fever, miliary tuberculosis, scistosomiasis, brucellosis, and leukemia. PKDL should also be differentiated

Laboratory findings associated with classic Kala azar include anemia (hemoglobulin 5-8 mg/ dl), thrombocytopenia, leucopenia (2000-3000 cells/µL), elevated hepatic transaminase levels,

Direct visualization of amastigotes in clinical specimens is the diagnostic gold standard in regions where tissue aspiration is feasible and microscopy and technical skill are available. [24] Microscopy of bone marrow aspirates is the safest diagnostic approach for paediatric patients, with amastigotes seen in more than 90% of cases by an experienced observer. The higher diagnostic efficacy of the bone marrow examination in children is probably related to the heavier parasitisation encountered in children. Microscopic examination of splenic aspirates offers the highest sensitivity (up to 98%), but is assoiated with the risk of lfe-threatening haemorrhage in cases with profound thrombocytopenia. [1] The results of culture in Novy-McNeal-Nicole (NNN) and RPMI 1640 media have been disappointing in one study. [24]

Serological methods are highly sensitive and non-invasive. They are comparatively more suited for diagnosing VL in endemic regions. These methods are either based on detection of

from yaws, syphilis, leprosy, and muco-cutaneous leishmaniasis. [1, 2]

234 Leishmaniasis - Trends in Epidemiology, Diagnosis and Treatment

**Figure 6.** Amastigotes forms of *Leishmania spp* by Giemsa stain

**4. Serological methods**

and hyper globulinemia (> 5gm/dl) that is mostly immunoglobulin G (IgG). [2]

**3. Demonstration (microscopy) and isolation of parasite (culture)**

*2.4.1. Investigation*

**(Figure 6)**

### A K M Mamunur Rashid

Department of Paediatrics, Khulna Medical College, Khulna, Bangladesh
