{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T07:15:50Z","timestamp":1785222950528,"version":"3.55.0"},"reference-count":10,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T00:00:00Z","timestamp":1610582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>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 <jats:italic>Phlebotomus martini<\/jats:italic> 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.<\/jats:p>","DOI":"10.1371\/journal.pntd.0008925","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T18:26:58Z","timestamp":1610648818000},"page":"e0008925","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Skin maculae, chronic diarrhea, cachexia, and splenomegaly\u2014Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9838-9805","authenticated-orcid":true,"given":"Oliver","family":"Henke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscus John","family":"Mapendo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7226-0168","authenticated-orcid":true,"given":"Alex","family":"Mremi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian Gasper","family":"Mmbaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Elisha","family":"Pallangyo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Harbaum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elifuraha","family":"Mkwizu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,1,14]]},"reference":[{"key":"pntd.0008925.ref001","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1186\/s13071-016-1743-7","article-title":"A review of visceral leishmaniasis during the conflict in South Sudan and the consequences for East African countries","volume":"9","author":"W Al-Salem","year":"2016","journal-title":"Parasit Vectors"},{"key":"pntd.0008925.ref002","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1016\/j.trstmh.2007.06.001","article-title":"Visceral leishmaniasis in eastern Africa\u2014current status","volume":"101","author":"R Reithinger","year":"2007","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0008925.ref003","article-title":"Leishmaniasis","author":"WHO","year":"2018","journal-title":"Epidemiological situation"},{"issue":"1","key":"pntd.0008925.ref004","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1603\/ME12147","article-title":"First report of the visceral leishmaniasis vector Phlebotomus martini (Diptera: Psychodidae) in Tanzania","volume":"50","author":"J Clark","year":"2013","journal-title":"J Med Entomol"},{"issue":"1","key":"pntd.0008925.ref005","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4103\/1995-7645.273572","article-title":"Sandfly fauna and ecological analysis of Phlebotomus orientalis and Phlebotomus martini in the lowland foci of visceral leishmaniasis in Somali Regional State, southeast Ethiopia","volume":"13","author":"A Gebresilassie","year":"2020","journal-title":"Asian Pac J Trop Med"},{"issue":"9","key":"pntd.0008925.ref006","doi-asserted-by":"crossref","first-page":"e2441","DOI":"10.1371\/journal.pntd.0002441","article-title":"Validation of two rapid diagnostic tests for visceral leishmaniasis in Kenya","volume":"7","author":"J Mbui","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0008925.ref007","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S1007-4376(09)60032-0","article-title":"A Review of Leishmaniasis in Easter Africa","volume":"23","author":"P Ngure","year":"2009","journal-title":"Journal of Nanjing Medical University"},{"key":"pntd.0008925.ref008","unstructured":"Republic of Sudan. 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[online] [viewed on 25.03.2020]; available from: https:\/\/www.who.int\/leishmaniasis\/burden\/Manual_for_the_diagnosis_and_treatment_Leishmaniasis_Guideline_Sudan_2014.pdf?ua=1."},{"issue":"6","key":"pntd.0008925.ref009","first-page":"309","article-title":"Chronic diarrhea and malabsorption caused by Leishmania donovani","volume":"25","author":"C Baba","year":"2006","journal-title":"Indian J Gastroenterol"},{"issue":"1","key":"pntd.0008925.ref010","doi-asserted-by":"crossref","first-page":"24","DOI":"10.4269\/ajtmh.16-84256","article-title":"Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)","volume":"96","author":"N Aronson","year":"2017","journal-title":"American Journal of Tropical Medicine"}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0008925","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T18:27:44Z","timestamp":1610648864000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0008925"}},"subtitle":[],"editor":[{"given":"Sreenivas","family":"Gannavaram","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,1,14]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0008925","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,14]]}}}