From the Guidelines
Fibroscans can be useful in assessing liver fibrosis in patients with visceral leishmaniasis (VL), though they are not routinely required for diagnosis. Visceral leishmaniasis commonly affects the liver, causing hepatomegaly and potential fibrosis due to the parasitic infection. When liver involvement is suspected, a FibroScan (transient elastography) can non-invasively measure liver stiffness to evaluate the degree of fibrosis without requiring an invasive liver biopsy.
Key Points to Consider
- The primary management of visceral leishmaniasis involves treating the underlying infection with medications such as liposomal amphotericin B (preferred, typically 3-5 mg/kg daily for 3-5 days), miltefosine (2.5 mg/kg/day for 28 days), or pentavalent antimonials (20 mg/kg/day for 28-30 days) 1.
- Liver function should be monitored during treatment as some antileishmanial drugs can be hepatotoxic.
- FibroScan results may help guide treatment decisions and follow-up care, particularly in patients with pre-existing liver conditions or those showing signs of significant hepatic involvement.
- After successful treatment of the infection, repeat FibroScan assessments may be valuable to monitor for resolution of fibrosis, though improvement in liver parameters typically follows successful parasite clearance.
- A recent study published in 2024 recommends using FibroScan to rule out patients with compensated advanced chronic liver disease (cACLD) with a value of <10 kPa, and a value of ≥15 kPa is highly suggestive of cACLD 1.
- Another study published in 2021 suggests using a low cutoff of 8.0 kPa to exclude clinically significant fibrosis and an upper cutoff of 12.0 kPa to indicate likely clinically significant fibrosis 1.
Recommendations for Use
- FibroScan can be a useful tool in assessing liver fibrosis in patients with VL, particularly in those with suspected liver involvement or pre-existing liver conditions.
- The test can help guide treatment decisions and monitor for resolution of fibrosis after successful treatment of the infection.
- However, it is essential to interpret FibroScan results in the context of the patient's overall clinical presentation and other diagnostic findings.
From the Research
Visceral Leishmaniasis Diagnosis and Treatment
- Visceral leishmaniasis (VL) is a systemic protozoan disease that requires early and accurate diagnosis and treatment for control 2.
- The current diagnostic tests for VL have limitations, and new diagnostic tools are needed to identify treatment failures 2, 3.
- The treatment of VL has problems relating to efficacy, adverse effects, and cost, making it a complex issue 4.
Liver Morphology and Function in Visceral Leishmaniasis
- Visceral leishmaniasis causes morphological and functional disturbance in the liver, with findings including Kupffer cells and macrophages colonized by leishmania parasites, chronic mononuclear cell infiltrate, and fibrosis 5.
- Liver function improves after treatment with pentovalent antimony 5.
Advances in Treatment
- Significant progress has been made towards the development of new and less toxic antileishmanial agents, including the oral agent miltefosine 6.
- Combination regimens should be further investigated in large trials to preserve the activity of available antileishmanial agents and minimize costs in poor endemic areas 6.