1/28. Kala-azar in zambia: first report of two cases.Two autochthonous cases of kala-azar, the first such report of the disease from Central and Southern africa, are described. Both patients presented with generalized macules, papules and nodules without ulceration and both also had tuberculosis. Amastigotes were cultured from blood and identified in skin, bone marrow, liver and spleen.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
2/28. Visceral leishmaniasis in costa rica: first case report.We describe a 15-month-old eutrophic immunocompetent male who presented with fever, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Leishmania amastigotes were identified in spleen and bone marrow specimens. In addition, tissue culture, animal inoculation, and isoenzyme analysis identified the parasite as leishmania donovani infantum or leishmania donovani chagasi. The infant was successfully treated with an antimonial drug. These findings represent the first case of visceral leishmaniasis reported in costa rica.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
3/28. Congenital transmission of visceral leishmaniasis (Kala Azar) from an asymptomatic mother to her child.In this article, we report the case of a 16-month-old German boy who was admitted to the Children's Hospital of Stuttgart with a 4-week history of intermittent fever, decreased appetite, weakness, fatigue, and difficulty sleeping. He was healthy at birth and remained so for the first 15 months of his life. On admission, physical examination showed enlarged cervical, axillary, and inguinal lymph nodes, as well as hepatosplenomegaly. Laboratory data revealed pancytopenia, elevated liver function tests, and hypergammaglobulinemia. blood, stool, and urine culture results were negative. Viral infections and rheumatologic and autoimmune disorders were ruled out, but a positive titer for Leishmania antibodies was noted. In a liver and bone marrow biopsy, the amastigote form of the parasite could not be seen in cells. The promastigote form of Leishmania was found and the diagnosis of visceral leishmaniasis was made by combining the cultures of both the liver and the bone marrow biopsy material in 5 mL 0.9% saline on brain heart infusion agar, supplemented with defibrinated rabbit blood and incubated at 25 to 26 degrees C for 5 days. The parasite was identified by Southern blot analysis as leishmania infantum. Specific therapy with the antimonial compound sodium stibogluconate with a dose of 20 mg/kg body weight was begun immediately. Within 4 days, the patient became afebrile. The side effects of treatment, including erosive gastritis, cholelithiasis, worsening hepatosplenomegaly, elevation of liver enzymes, pancreatitis, and electrocardiogram abnormalities, necessitated the discontinuation of treatment after 17 days. On discharge 4 weeks later, the patient was stabilized and afebrile with a normal spleen, normal complete blood count, normal gammaglobulins, and decreasing antibody titers to Leishmania. During the next 24 months, the patient experienced intermittent episodes of abdominal pain, decreased appetite, recurrent arthralgia, and myalgia. But at his last examination in January 1998, he was well; all symptoms mentioned above had disappeared. Because the child had never left germany, nonvector transmission was suspected and household contacts were examined. His mother was the only one who had a positive antibody titer against leishmania donovani complex. She had traveled several times to endemic Mediterranean areas (portugal, malta, and Corse) before giving birth to the boy. But she had never been symptomatic for visceral leishmaniasis. Her bone marrow, spleen, and liver biopsy results were within normal limits. culture results and polymerase chain reaction of this material were negative. A montenegro skin test result was positive, indicating a previous infection with Leishmania. Western blot analysis showed specific recognition by maternal antibodies of antigens of Leishmania cultured from the boy's tissue. Visceral leishmaniasis is endemic to several tropical and subtropical countries, but also to the mediterranean region. It is transmitted by the sand fly (phlebotomus, Lutzomyia). Occasional nonvector transmissions also have been reported through blood transfusions, sexual intercourse, organ transplants, excrements of dogs, and sporadically outside endemic areas. Only 8 cases of congenital acquired disease have been described before 1995, when our case occurred. In our patient, additional evaluation showed that the asymptomatic mother must have had a subclinical infection with Leishmania that was reactivated by pregnancy, and then congenitally transmitted to the child. Visceral leishmaniasis has to be considered in children with fever, pancytopenia, and splenomegaly, even if the child has not been to an endemic area and even if there is no evidence of the disease in his environment, because leishmaniasis can be transmitted congenitally from an asymptomatic mother to her child.- - - - - - - - - - ranking = 2keywords = spleen (Clic here for more details about this article) |
4/28. Pancreatic involvement in co-infection visceral leishmaniasis and hiv: histological and ultrastructural aspects.The involvement of the gastrointestinal tract in the co-infection of hiv and Leishmania is rarely reported. We report the case of an hiv-infected adult man co-infected with a disseminated form of leishmaniasis involving the liver, lymph nodes, spleen and, as a feature reported for the first time in the English literature, the pancreas. light microscopy showed amastigote forms of Leishmania in pancreatic macrophages and immunohistochemical staining revealed antigens for Leishmania and also for hiv p24. Microscopic and ultrastructural analysis revealed severe acinar atrophy, decreased zymogen granules in the acinar cytoplasm and also nuclear abnormalities such as pyknosis, hyperchromatism and thickened chromatin. These findings might correspond to the histologic pattern of protein-energy malnutrition in the pancreas as shown in our previous study in pancreas with AIDS and no Leishmania. In this particular case, the protein-energy malnutrition may be due to cirrhosis, or, Leishmania or hiv infection or all mixed. We believe that this case represents the morphologic substratum of the protein energy malnutrition in pancreas induced by the hiv infection. Further studies are needed to elucidate these issues.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
5/28. The review of imported visceral leishmaniosis in the czech republic.BACKGROUND: From the late 1950s through 2000, a total of 8 cases of imported visceral leishmaniosis (VL) were registered in the czech republic. OBJECTIVES: The authors were made to point to the issue of imported VL by the fact 3 cases of this disease (imported from East africa, croatia, and southern italy) were reported in 1999, plus another one (again imported from croatia) in 2000. methods: The case reports of 4 cases of imported VL are presented. They are cases 5-8 ever reported in the czech republic. RESULTS: The infection manifested itself by fever, marked splenomegaly, leukopenia, thrombocytopenia, and rapid weight loss. The diagnosis was confirmed by the microscopic finding of amastigotes in punctate obtained from bone marrow, liver, spleen and, also, by serology. All the patients were successfully treated with amphotericin b. CONCLUSION: infection by VL should be considered when establishing the diagnosis not only in patient returning from endemic regions and show hepatosplenomegaly, fever, leukopenia, and thrombocytopenia. Given the long incubation time, VL may be encountered also in foreigners who had lived in the above regions. Besides, the diagnosis of VL should also be considered in immunocompromised individuals. (Ref. 27.).- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
6/28. Secondary myelofibrosis in visceral leishmaniasis--case report.A 39-year-old woman with a history of travel to the Montenegrin coast presented with a 9-month long history of fever and weakness, and on examination was found to be emaciated with hepatosplenomegaly and pancytopenia. Marrow aspiration showed poor cellularity with abundant Leishman Donovan (LD) bodies in the macrophages. bone marrow trephine biopsy revealed a marked myelofibrosis (Manoharan classification: grade III) with osteosclerosis. The impression smears of a trephine biopsy stained with Guiemsa also showed LD bodies. The patient did not exhibit evidence of any risk factors for visceral leishmaniasis (VL). She was treated with meglumine antimoniate (Glucantime) without any adverse effect. The spleen returned to a normal volume after 4 months and bone marrow trephine biopsy performed 6 months after initiation of the therapy had returned to normal. A diagnosis was difficult to establish as VL is rarely encountered in the continental parts of yugoslavia, and with the presence of associated myelofibrosis it could easily have been mistaken for chronic idiopathic myelofibrosis. The association of myelofibrosis with visceral leishmaniasis has been reported in the literature only three times; we thus feel that documentation of this case is merited.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
7/28. Liver-spleen scintiscan in kala-azar: case report.Massive splenomegaly was found in a liver-spleen scan in a young man from greece. Kala-azar was suggested as a possible cause and was confirmed by culturing leishmania donovani from the bone marrow aspirate. The differential diagnosis of massive splenomegaly should include kala-azar when a patient has been in an endemic area.- - - - - - - - - - ranking = 5keywords = spleen (Clic here for more details about this article) |
8/28. Visceral leishmaniasis caused by Leishmania (Viannia) braziliensis in a patient infected with human immunodeficiency virus.The current article reports the case of a 19-month-old-girl, from the state of Minas Gerais, brazil, with visceral leishmaniasis, by Leishmania (Viannia) braziliensis, and Human Immunodeficiency Virus (hiv) co-infection. The child's mother and father, aged 22 and 27 years old, respectively, were both hiv positive. The child was admitted to the General Pediatric Center, in Belo Horizonte, presenting high fever, fatigue, weight loss and enlargement of liver and spleen. Indirect immunofluorescent test revealed a titer of 1:320 for Leishmania. Such result was confirmed by the presence of amastigotes in bone marrow aspirate samples and culture of promastigote forms. parasites were identified as being Leishmania (Viannia) braziliensis through PCR, using a L. braziliensis complex primer and a generic primer, followed by hibridization. Specific leishmaniasis therapy (Glucantime register mark or target antimonial) was intravenously administered.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
9/28. leishmaniasis diagnosed from bronchoalveolar lavage.A 51-year-old renal transplant patient, whose spleen had been removed 11 years ago, was admitted to hospital for elective surgery, which was cancelled as she developed spiking fever and nonproductive cough and her general condition deteriorated. After 2 weeks, leishmaniasis was unexpectedly diagnosed from a bronchoalveolar lavage specimen, which had been subjected to parasitological examination under the suspicion of pneumocystosis. Isoenzyme typing identified the parasite as leishmania infantum. The patient had visited Malaga, spain, twice a year, the last trip taking place 1 month before admission. Specific treatment was followed by rapid recovery without relapse during 1.5 years. splenectomy and immunosuppressive medication obscured the clinical suspicion of leishmaniasis. The case is a reminder of the interstitial pneumonitis in leishmaniasis and emphasizes the value of broad-spectrum methods detecting a variety of parasites.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
10/28. Visceral leishmaniasis with multiple nodular lesions of the liver and spleen: CT and sonographic findings.Visceral leishmaniasis is a severe disease caused by the intracellular protozoa leishmania donovani. diagnosis is based on examination of bone marrow or serology. The role of imaging techniques as diagnostic tools remains to be established in visceral leishmaniasis. We report multiple nodular lesions in the liver and spleen on ultrasonography and computed tomography in a patient with visceral leishmaniasis. To our knowledge, this is the first reported case of multiple nodular hepatosplenic lesions in visceral leishmaniasis.- - - - - - - - - - ranking = 5keywords = spleen (Clic here for more details about this article) |
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