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Visceral leishmaniasis (VL) or kala-azar, is a disease caused by the parasite Leishmania donovani, which is transmitted by the bite of sandflies. The clinical disease is characterized by fever, anemia, leukopenia (reduced white cell count), and hepatosplenomegaly (enlargement of the liver and spleen), and in full blown cases, by marked immunologic dysfunction. Cachectin, or tumor necrosis factor-alpha (TNF-alpha), is a cytokine, a nonantibody protein produced in response to specific antigenic stimuli. It acts as an intercellular mediator, and is believed to play a role in the mediation of normal cellular function, inflammation, and in the body's response to bacterial or parasitic infection. The levels of TNF-alpha in patients with VL were measured to assess the possibility of using these levels as indicators of the progress of the disease. The study group consisted of 58 patients with VL; 28 patients with acute disease, and 30 with cryptic disease. Cryptic disease patients had no symptoms of VL, but had a positive skin test, indicating an immune response to the infection. Fifteen healthy volunteers comprised the control group. Blood levels of TNF-alpha were elevated in the patients with acute VL prior to treatment and fell afterward. In cases refractory (resistant) to treatment, TNF-alpha levels remained high. Normal levels were observed in the asymptomatic and control groups. Levels of TNF-alpha appear to be a suitable marker for measuring the progress of VL and patient response to therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)