Visceral leishmaniasis (VL), known as kala azar in India, is the cause of much death and disease in developing countries. It is one of several diseases caused by over 20 species of Leishmania; it is transmitted by Sandfly bi- tes [1] . The infection of humans appears with multiple clinical manifestations, including cutaneous (CL), muco- cutaneous, diffuse and VL. The latter is responsible for approximately 59,000 deaths per year, a parasitic disease surpassed only by malaria [2] [3] . There are two types of VL, anthroponotic and zoonotic. Zoonotic VL (ZVL) is widespread and occurs in Latin America, Northern Africa, Southern Europe and in areas of the Middle East and Asia [2] -[4] . Two forms of leishmaniasis (VL and CL) present in Europe are caused by Leishmania infan- tum [4] . While cases of cutaneous leishmaniosis were reported in France, Italy and Spain, ZVL is endemic in all countries bordering the Mediterranean Sea [5] .

Geographically, the distribution of leishmaniasis is limited by the distribution of its vector Sandfly species. The Sandfly vectors are mainly active during the night, and therefore the highest risk for contracting the infec- tive stages of the parasite from Sandfly bites is between dusk and dawn [6] . The reservoirs of the pathogen can be several wild and domestic canid and rodent species, but domestic dogs are considered as the main reservoir of Leishmania infantum playing a key role as the source of human infection. Indeed, there is a clear association between a high rate of infection in dogs and an increased risk of human disease [2] [7] .

VL is endemic in 62 countries, with a total of 200 million people at risk, an estimated 500,000 new cases each year worldwide, and 41,000 recorded deaths in the year 2000 [8] [9] . As is the case for other tropical diseases, epidemiological data are incomplete, and official figures are likely to underestimate grossly the real prevalence of the disease [10] . Both the number of recorded cases and the geographic areas affected have grown in the past two decades [11] .

Delays and difficulty in diagnosis are common due to the long incubation period of the agent, nonspecific symptoms, and the difficulty of identifying the intracellular protozoa (Donovan bodies) in tissue aspirates. It is usually diagnosed by serology or bone marrow examination. Liver biopsy is rarely required for diagnosis [12] . The role of imaging techniques as diagnostic tools remains to be established in VL [13] . This study designed with an aim to assess the consequences of VL in the liver, spleen and pancreas of the affected participants by using ultrasound, which will contribute in the treatment of the disease in an early period, before the exacerbation of complications and the condition become difficult to control.

Study population comprised 100 positive participants to VL (84% males and 16% females). Participants’ ages ranged from 15 to 45 years; with a mean age of (29.8 ± 2.2) years (Table 1). Out of the scanned participants, a total of 34 subjects were in the age group (35 - 39) years, representatives (34%) of the population. The age group of (40 - 45) years was the smallest and representing only (6%) of the population (Table 1). The highest mean ± SD of ages was (43 ± 1.4) years and found in the age group 40 - 45 years, while the lowest mean ± SD of ages was (18 ± 1.4) years found in the age group 15 - 19 years (Table 1).

Regarding symptoms and signs of VL; abdominal distention was detected in (50%) of participants, while he- pato-splenomegaly, weight loss and fever were present in (100%) of participants. Cough and diarrhoea were the least clinical features detected only in (2%) of participants for each (Table 2). Sonographically, hepatic compli- cations of VL were hepatic lesions as hepatomegaly (100%), increased liver echogenicity (18%), dilated portal vein (7%), and shrinkage liver (4%) (Table 3).

In the Spleens of the affected participants, ultrasound detects features of splenomegaly (100%), hypoechoic spleen (19%), and focal splenic lesion (34%). While in pancreas, acute pancreatitis (2%) and decreased pancrea- tic echogenicity (1%) were the commonest sonographic findings (Table 3). Other complications of VL such as ascites (50%) and lymphadenopathy (35%) were also detected (Table 3).

Kala azar is a protozoal infection common in developing countries; there are an estimated 500,000 new cases

every year and there were 41,000 recorded deaths in the year 2000 [23] . From the early 1900s, VL has been among the most important health problems in Sudan, particularly in the main endemic area in the eastern and central regions. Several major epidemics have occurred—in the Western Upper Nile province in southern Sudan, detected in 1988—and the most recent claiming over 100,000 lives [24] .

Delay and difficulty in diagnosis are common, especially in the early stage of the disease, due to non-specific symptomatology and difficulty in demonstrating intracellular protozoa in tissue aspirates [25] . In this study there was a wild diversity in clinical patterns (Table 2) and this was caused because the pathogenicity depends mainly on parasite genotype versus host immungenetic profile [26] .

Study results showed that abdominal ultrasound can detect the changes occur in organ size as well as to dem- onstrate the echo texture changes—hyper or hypo echogenicity—in case of VL complications in liver, spleen and pancreases (Table 3). Such findings were confirmed in another study of ultrasound findings in patients with VL, where their results showed that abdominal ultrasound can detect the changes in organ size in an appropriate manner as well as to demonstrate the echo texture changes as hyper or hypo echogenicity in case of inflamma- tion as pancreatitis and renal inflammatory diseases resulted from VL [27] .

Also ultrasound findings of hepatosplenomegaly, and abdominal lymphadenopathy secondary to VL had been reported when VL was diagnosed by ultrasound guided fine needle aspiration of an axillary node and when ul- trasound is used to study changes occur in the organ parenchyma in VL participants [28] [29] .

Abdominal ultrasound has the capability to diagnose VL and differentiating it from mimicking conditions, in complement with other laboratory tests. Delayed diagnosis due to a typical manifestation can lead to fatal out- come in patients. Instead of relying solely on the classical clinical features of visceral leishmaniasis, simple ab- dominal ultrasound examination can help to make an early diagnosis even in atypical cases, thereby reducing the mortality of visceral leishmaniasis. The use of ultrasound as a primary model in the diagnosis of patients with VL, and characterization of the signs and complications in Tropical Sudanese hospitals is enlightening.

This study is limited because the obtained results cannot be applied to the whole society in Sudan, because it was conducted only in Khartoum state rather than other states in Sudan.

In conclusion, ultrasound scanning presents to be an effective tool in the diagnosis of VL consequences because of its ability to detect these complications in various abdominal organs such as liver, spleen and pancreas, which in turn allowing the possibility of prevent and treat related deterioration in the patient’s health status.

The author would like to thank the staff of the ultrasound department at the Tropical Disease Hospital (TDH) for their cooperation and support during data collection.