Utility of chest imaging in the diagnosis and management of patients with visceral leishmaniasis: A systematic review

Tesfahunegn Hailemariam; Yonas Mebratu; Tsion Andrias; Fikremariam Melkeneh; Abel Abebe; Biruk Mulualem; Zewdu Abadi; Wazema Desta; Selamawit Bedasso; Fekadu Belay; Abibual Sileshi; Elilta Desta; Felipe Velsaquez-Botero; Rahel Birhane; Francesco Marinucci; Tsegahun Manyazewal

doi:10.1177/20503121231177812

Utility of chest imaging in the diagnosis and management of patients with visceral leishmaniasis: A systematic review

SAGE Open Med. 2023 May 29:11:20503121231177812. doi: 10.1177/20503121231177812. eCollection 2023.

Authors

Tesfahunegn Hailemariam¹, Yonas Mebratu², Tsion Andrias³, Fikremariam Melkeneh⁴, Abel Abebe⁵, Biruk Mulualem⁶, Zewdu Abadi⁷, Wazema Desta⁸, Selamawit Bedasso⁹, Fekadu Belay¹⁰, Abibual Sileshi¹¹, Elilta Desta¹², Felipe Velsaquez-Botero¹³, Rahel Birhane¹, Francesco Marinucci¹⁴, Tsegahun Manyazewal¹

Affiliations

¹ Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
² London School of Hygiene & Tropical Medicine, London, UK.
³ Private Hospitals Association, Addis Ababa, Ethiopia.
⁴ Clinical Governance and Quality Improvement Unit, Teklehaimanot General Hospital, Addis Ababa, Ethiopia.
⁵ Detroit Medical Center/Wayne State University, Sinai Grace Hospital, Detroit, MI, USA.
⁶ Department of Radiology, College of Medicine and Health Sciences, Bahir Dar University, Bahirdar, Ethiopia.
⁷ Jinka General Hospital, Jinka, Ethiopia.
⁸ Health Policy Department, Health Professionals Network for Tigray Takoma Park, MD, USA.
⁹ ALERT Hospital/Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
¹⁰ Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.
¹¹ Infectious Diseases Unit, Amdework Primary Hospital, Wag Hemra Zone, Ethiopia.
¹² Park Pediatrics Clinic, Takoma Park, MD, USA.
¹³ Larkin Community Hospital, CES University, Miami, FL, USA.
¹⁴ Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.

Abstract

Objectives: Visceral leishmaniasis remains a deadly parasitic disease with diagnostic complexities. Currently, point-of-care chest imaging is gaining momentum in the diagnosis of infectious diseases. Respiratory symptoms are common in visceral leishmaniasis. Here we aimed to systematically synthesize the evidence on the utility of chest imaging on the diagnosis and management of patients with visceral leishmaniasis.

Methods: We searched PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar databases for studies reporting chest imaging findings in patients with visceral leishmaniasis, published in English from database inception to November 2022. We used the Joanna Briggs Institute checklists to evaluate the risk of bias. The protocol of this systematic review was registered with the Open Science Framework: https://doi.org/10.17605/OSF.IO/XP24W.

Results: Of 1792 studies initially retrieved, 17 studies with 59 participants were included. Of the 59 patients, 51% (30) had respiratory symptoms and 20% (12) were human immunodeficiency virus co-infected. Chest X-ray, high-resolution computed tomography, and chest ultrasound findings were available for 95% (56), 93% (55), and 2% (1) of the patients, respectively. The most common findings were pleural effusion (20%; 12), reticular opacities (14%; 8), ground-glass opacities (12%; 7), and mediastinal lymphadenopathies (10%; 6). High-resolution computed tomography was more sensitive than chest X-ray and detected lesions that were lost on chest X-ray, 62% (37) versus 29% (17). In almost all cases, regression of the lesions was observed with treatment. Microscopy of pleural or lung biopsy detected amastigotes. Polymerase chain reaction yield was better in pleural and bronchoalveolar lavage fluids. A parasitological diagnosis from pleural and pericardial fluid was possible in AIDS patients. Overall, the risk of bias was low.

Conclusions: Visceral leishmaniasis patients frequently had abnormal findings on high-resolution computed tomography. Chest ultrasound is a useful alternative in resource-limited settings to aid in diagnosis and subsequent treatment follow-up, especially when routine tests yield negative results despite clinical suspicion.

Keywords: Visceral leishmaniasis; chest X-ray; chest ultrasound; diagnostic imaging; high-resolution computed tomography; point-of-care ultrasound; tropical diseases.

Publication types

Review