title: Clinical features, diagnostic tools, and treatment regimens for visceral leishmaniasis in Bulgaria.
abstract: OBJECTIVE
  Visceral leishmaniasis (VL), caused by the parasite Leishmania infantum, which was once largely confined to Southern Europe is now being diagnosed throughout Northern Europe, including Great Britain. In an effort to help EU clinicians improve their diagnosis and management of VL, this paper defines clinical features typical of the disease as it presents in Bulgaria, where VL is endemic.
  
  
  METHODS
  The list of clinical symptoms presented here was gleaned from the medical records (patient histories, epidemiological survey cards, laboratory data) of 59 Bulgarian patients with VL. This study also includes microscopic, serological, and molecular laboratory techniques.
  
  
  RESULTS
  Described and analyzed are the clinical features, diagnostic techniques, and therapeutic regimens of 59 cases--part of the total number of VL case histories (P = 120, 116 Bulgarian and 4 not Bulgarian) collected in Bulgaria over the past 24 years (1988-2011). Although all of the studied 59 cases presented with classical symptoms of VL, only in three occasions, the initial diagnosis was correct.
  
  
  CONCLUSIONS
  Left untreated, zooanthroponotic VL leads to debilitating chronic disease and even death. Yet, because VL is hard to recognize and relatively new to Northern Europe, misdiagnosis is common and treatment too often inappropriate and delayed.
authors.affiliation: National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria. harizanov@ncipd.org
authors.forename: Rumen N
authors.initials: RN
authors.lastname: Harizanov
authors.forename: Iskren T
authors.initials: IT
authors.lastname: Kaftandjiev
authors.forename: Diana P
authors.initials: DP
authors.lastname: Jordanova
authors.forename: Irina B
authors.initials: IB
authors.lastname: Marinova
authors.forename: Nina D
authors.initials: ND
authors.lastname: Tsvetkova
mesh_terms: D000328:Adult; D000368:Aged; D000871:Anthelmintics / Q000627:therapeutic use; D002031:Bulgaria / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000379:methods; D015510:Clinical Medicine / Q000379:methods; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D018314:Leishmania infantum / Q000302:isolation & purification*; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000871:Anthelmintics
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