An acute presentation of haemophagocytic lymphohistiocytosis due to visceral leishmaniasis in a British adult returning traveller

A 62-year old British Caucasian woman normally resident in Spain presented with fever and pancytopaenia after returning to the UK. Her symptoms persisted despite broad-spectrum antibiotics, and she gradually became confused, hypotensive and progressively more pancytopaenic. Imaging demonstrated hepatosplenomegaly, and a bone marrow aspirate confirmed a diagnosis of haemophagocytic lymphohistiocytosis (HLH). Bone marrow polymerase chain reaction (PCR) and blood serology were both positive for Leishmania donovani, consistent with visceral leishmaniasis (VL). Following treatment with dexamethasone and amphotericin, she improved clinically and biochemically, and was able to return to Spain. Fever in the returning traveller is a common acute medical presentation. Although HLH and VL are rare diagnoses, both carry a very high mortality rate if undiagnosed and untreated.

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Comparative Study of Microscopy and Polymerase Chain Reaction for the Diagnosis of Suspected Visceral Leishmaniasis Patients in Nepal

Kathmandu University Medical Journal ◽

10.3126/kumj.v11i1.11016 ◽

2014 ◽

Vol 11 (1) ◽

pp. 14-17 ◽

Cited By ~ 1

Author(s):

K Pandey ◽

AK Mallik ◽

S Pyakurel ◽

SB Pun ◽

BD Pandey

Keyword(s):

Bone Marrow ◽

Polymerase Chain Reaction ◽

Visceral Leishmaniasis ◽

Leishmania Donovani ◽

Polymerase Chain Reaction Amplification ◽

Public Health Problem ◽

Major Public Health Problem ◽

Chain Reaction ◽

Polymerase Chain ◽

Endemic Areas

Background Visceral leishmaniasis is potentially fatal protozoan diseases caused by Leishmania donovani. Nepal is an endemic region in which visceral leishmaniasis causes a major public health problem in the lowland areas that border the endemic areas of Bihar state in India. Accurate diagnosis to inform treatment is a first step in achieving the goal of visceral leishmaniasis elimination from South East Asian regions by 2020. Objective The objective of the present study was to compare between the Microcopy and polymerase chain reaction for diagnosis of visceral leishmaniasis. Methods In the present study, 236 bone marrow aspirations were collected from suspected visceral leishmaniasis patients in Janakpur Zonal Hospital, Dhanusa district, Terai region of Nepal in between 2003-2007. We evaluated bone marrow samples by microscopic examination with subsequent testing of the same sample by polymerase chain reaction and sequence analysis. Results Giemsa’s solution stained bone marrow slides stored for over five years were used for polymerase chain reaction amplification. The result showed that 71% were polymerase chain reaction positive and 56% were microscopic positive. Out of 104 microscopic negative bone marrow samples, 15% of samples were positive by polymerase chain reaction. Conclusion Polymerase chain reaction could make a very good option for diagnosis by using less or non-invasive material from visceral leishmaniasis patients in endemic areas of Nepal. DOI: http://dx.doi.org/10.3126/kumj.v11i1.11016 Kathmandu University Medical Journal Vol.11(1) 2013: 14-17

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Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652012000100008 ◽

2012 ◽

Vol 54 (1) ◽

pp. 43-47 ◽

Cited By ~ 14

Author(s):

Aracele Tenório de Almeida e Cavalcanti ◽

Zulma Medeiros ◽

Fábio Lopes ◽

Luiz Dias de Andrade ◽

Valéria de Melo Ferreira ◽

...

Keyword(s):

Bone Marrow ◽

Polymerase Chain Reaction ◽

Visceral Leishmaniasis ◽

Bone Marrow Aspirate ◽

Latex Agglutination ◽

Agglutination Test ◽

Direct Agglutination Test ◽

Chain Reaction ◽

Dipstick Test ◽

Polymerase Chain

HIV/AIDS-associated visceral leishmaniasis may display the characteristics of an aggressive disease or without specific symptoms at all, thus making diagnosis difficult. The present study describes the results of diagnostic tests applied to a series of suspected VL cases in HIV-infected/AIDS patients admitted in referral hospitals in Pernambuco, Brazil. From a total of 14 eligible patients with cytopenias and/or fever of an unknown etiology, and indication of bone marrow aspirate, 10 patients were selected for inclusion in the study. Diagnosis was confirmed by the following examinations: Leishmania detection in bone marrow aspirate, direct agglutination test, indirect immunofluorescence, rK39 dipstick test, polymerase chain reaction and latex agglutination test. Five out of the ten patients were diagnosed with co-infection. A positive direct agglutination test was recorded for all five co-infected patients, the Leishmania detection and latex agglutination tests were positive in four patients, the rK39 dipstick test in three, the indirect immunofluorescence in two and a positive polymerase chain reaction was recorded for one patient. This series of cases was the first to be conducted in Brazil using this set of tests in order to detect co-infection. However, no consensus has thus far been reached regarding the most appropriate examination for the screening and monitoring of this group of patients.

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Relapse of Visceral Leishmaniasis in an HIV-Infected Patient Successfully Treated with a Combination of Miltefosine and Amphotericin B

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2015/176545 ◽

2015 ◽

Vol 26 (6) ◽

pp. 325-329 ◽

Cited By ~ 3

Author(s):

Shauna McQuarrie ◽

Ken Kasper ◽

Dana C Moffatt ◽

Daniel Marko ◽

Yoav Keynan

Keyword(s):

Bone Marrow ◽

Visceral Leishmaniasis ◽

Amphotericin B ◽

Clinical Course ◽

Present Report ◽

Cd4 Count ◽

High Likelihood ◽

Gastrointestinal Involvement ◽

Chain Reaction ◽

Polymerase Chain

The present report documents a 49-year-old HIV-infected man receiving antiretroviral therapy with a suboptimal immune response and a CD4 count of 95 cells/mm3, despite virological suppression. Investigation of bone marrow was conducted and yielded a diagnosis of visceral leishmaniasis. The clinical course was complicated by gastrointestinal involvment and relapse occurred after amphotericin B therapy. With the addition of miltefosine, the patient no longer presented with bone marrow amastigotes, and displayed an increased CD4 count and negativeLeishmaniapolymerase chain reaction results. The present case highlights atypical presentation of visceral leishmaniasis, including poor immune reconstitution and gastrointestinal involvement. The high likelihood of relapse and response to combination therapy are illustrated.

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Assessment of a New Antigen Detection Test for the Diagnosis of Canine Visceral Leishmaniasis

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0125 ◽

2021 ◽

Author(s):

Claudia Abeijon ◽

Stefano Pizzirani ◽

Antonio Campos-Neto

Keyword(s):

Bone Marrow ◽

Visceral Leishmaniasis ◽

Protein Detection ◽

Antigen Detection ◽

Canine Visceral Leishmaniasis ◽

Chain Reaction ◽

Serological Tests ◽

Polymerase Chain ◽

Antigen Protein ◽

Simple Exposure

Canine visceral leishmaniasis (CVL) is a serious zoonotic disease in Brazil and Southern Europe. CVL is primarily caused by Leishmania infantum and its diagnosis relies primarily on detection of parasites in bone marrow or lymph node aspirates by microscopic observation of the parasites in stained smears, parasite culture, or polymerase chain reaction (PCR). Serological tests exist but they do not distinguish active disease from simple exposure to parasite antigens. Here, we have assessed the utility of a new monoclonal antibody––based antigen (protein) detection test for the diagnosis of CVL. The test was positive in 70% of beagle dogs experimentally infected with L. infantum. In contrast, culture of the parasites from bone marrow aspirates was positive in only 40% of the infected animals. These preliminary results suggest that this antigen detection test, which we have recently described for the diagnosis of human VL, has the potential to be a useful diagnostic tool for CVL.

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