Congenital kala-azar

An 11-month-old male infant was admitted to hospital with fever, pallor and hepatosplenomegaly, and was diagnosed as having kala-azar. The mother also suffered from kala-azar while carrying this baby. As the baby and the mother did not leave Delhi either during or after delivery, and the vector found in Delhi is not competent to transmit leishmaniasis, the infant could not have been infected by the bite of a sandfly. It therefore seems most likely that he was infected in utero--a rare route.