• history of exposure to the bite of sandflies
• history of being in an area known for leishmaniasis

Systemic illness (visceral leishmaniasis):

• fever, persistent, long duration (weeks), may cycle irregularly
• night sweats
• fatigue
• weakness
• appetite loss
• weight loss
• abdominal discomfort, vague
• vomiting (children)
• diarrhea (children)
• cough (children)
• scaly skin
• gray, dark, ashen skin
• thinning hair

Skin disease (cutaneous leishmaniasis):
Symptoms on the skin include:

• macule or papule, erythematous
• skin ulcer, forms at site of original lesion
• ulcer heals very slowly over a matter of months
• smaller lesions may form around the ulcer (satellite lesions)

Symptoms on mucous membranes include:

• nasal stuffiness
• runny nose
• nosebleed
• ulcers and erosion of tissue (mouth, tongue, gums, lips, nose, nasal septum)
• swallowing difficulty (dysphagia) with esophageal involvement
• breathing difficulty, with tracheal involvement

SIGNS

• enlarged spleen
• enlarged liver (less common than enlarged spleen)
• enlarged lymph nodes (less common than enlarged spleen)

TESTS
Systemic disease:

• skin test, called the Montenegro skin test
• skin biopsy
• biopsy of the spleen
• bone marrow biopsy
• lymph node biopsy
• culture of biopsy material
• indirect immunofluorescent antibody test
• direct agglutination assay

Other tests (complementary to the diagnosis)

• CBC (shows decreased cellularity of blood, pancytopenia)
• hemoglobin (shows signs of anemia)
• serum protein (decreased)
• serum albumin (decreased)
• immunoglobulins (increased)