title: Expansion of visceral leishmaniasis in the State of Rio de Janeiro, Brazil: report of the first autochthonous case in the municipality of Volta Redonda and the difficulty of diagnosis.
abstract: Visceral Leishmaniasis has been showing remarkable epidemiological changes in recent decades, with marked expansion and an emergence of cases in urban areas of the North, Southeast and Midwest regions of Brazil. The Kala-azar cases reported here, despite being very characteristic, presented a great difficulty of diagnosis, because the disease is not endemic in Volta Redonda. The child underwent two hospitalizations in different hospitals, but got the correct diagnosis only after 11 months of symptom onset. In this report we discuss the main differential diagnoses and call attention to the suspected symptoms of visceral leishmaniasis in patients with prolonged fever, hepatosplenomegaly and pancytopenia, even in areas not traditionally endemic for the disease.
authors.affiliation: Discipline of Infectious and Parasitic Diseases, School of Medicine at the University Center of Volta Redonda, State of Rio de Janeiro, Brazil.
authors.forename: Luiz Henrique Conde
authors.initials: LH
authors.lastname: Sangenis
authors.affiliation: Discipline of Pediatrics, School of Medicine at the University Center of Volta Redonda, State of Rio de Janeiro, Brazil.
authors.forename: Sebastião Roberto de Almeida
authors.initials: SR
authors.lastname: Lima
authors.affiliation: Laboratory for Leishmaniasis Surveillance, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, State of Rio de Janeiro, Brazil.
authors.forename: Cíntia Xavier
authors.initials: CX
authors.lastname: de Mello
authors.affiliation: Discipline of Pediatrics, School of Medicine at the University Center of Volta Redonda, State of Rio de Janeiro, Brazil.
authors.forename: Daniela Trindade
authors.initials: DT
authors.lastname: Cardoso
authors.affiliation: Discipline of Infectious and Parasitic Diseases, School of Medicine at the University Center of Volta Redonda, State of Rio de Janeiro, Brazil.
authors.forename: Jurema Nunes
authors.initials: JN
authors.lastname: Mello
authors.affiliation: Discipline of Infectious and Parasitic Diseases, School of Medicine at the University Center of Volta Redonda, State of Rio de Janeiro, Brazil.
authors.forename: Maria Cristina Carvalho do Espírito
authors.initials: MC
authors.lastname: Santo
authors.affiliation: Discipline of Infectious and Parasitic Diseases, School of Medicine at the University Center of Volta Redonda, State of Rio de Janeiro, Brazil.
authors.forename: Walter
authors.initials: W
authors.lastname: Tavares
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male