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Bélard S, Stratta E, Zhao A, Ritmeijer K, Moretó-Planas L, Fentress M, Nadimpalli A, Grobusch MP, Heller T, Heuvelings CC. Sonographic findings in visceral leishmaniasis - A narrative review. Travel Med Infect Dis 2020; 39:101924. [PMID: 33227498 DOI: 10.1016/j.tmaid.2020.101924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Visceral leishmaniasis (VL) is predominantly a neglected tropical parasitic disease but may also be acquired by travellers. We aimed at summarizing knowledge on sonographic presentation of VL to better understand sonographic features of VL. METHODS PubMed was searched for studies and case reports presenting original data on sonographic findings of VL, published before August 13th, 2019. Demographic, clinical, and sonographic data were extracted and summarized in a qualitative approach. RESULTS A total of 36 publications were included in this review; 27 of these were case reports and the remainder were prospective or retrospective studies. No study reported systematic cross-sectional comparative imaging. Overall, publications reported on 512 patients with VL of whom 12 were reported HIV-infected. Spleno- and hepatomegaly were the most frequently reported findings. Further relevant and repeatedly reported findings were splenic and hepatic lesions, abdominal lymphadenopathy, pleural and pericardial effusion and ascites. Reported focal splenic lesions were heterogeneous in size, shape, and echogenicity. Several publications reported gradual diminution and resolution of sonographic findings with VL treatment. CONCLUSION Available literature on sonographic findings of VL is limited. Available reports indicate that spleno- and hepatomegaly, free fluid, abdominal lymphadenopathy, and focal splenic lesions may be common sonographic features in patients with VL. Because of the apparent overlap of sonographic features of VL, extrapulmonary tuberculosis and other conditions, interpretation of sonographic findings needs to be made with particular caution.
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Affiliation(s)
- Sabine Bélard
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Erin Stratta
- Médecins Sans Frontières, 40 Rector St., 16th Floor, New York, NY, 10006, USA.
| | - Amelia Zhao
- Médecins Sans Frontières, 40 Rector St., 16th Floor, New York, NY, 10006, USA.
| | - Koert Ritmeijer
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, the Netherlands.
| | - Laura Moretó-Planas
- Médecins Sans Frontières, Medical Department, Carrer Zamora 54, Barcelona, 08005, Spain.
| | - Matthew Fentress
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK; Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA; University of California, Davis, 4860 Y St., Suite 2300, Sacramento, CA 95817, USA.
| | - Adi Nadimpalli
- Médecins Sans Frontières, 40 Rector St., 16th Floor, New York, NY, 10006, USA.
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD, Amsterdam, the Netherlands.
| | - Tom Heller
- Lighthouse Clinic, Kamuzu Central Hospital, Kamuzu Central Hospital Area 33 Mzimba Street, P.O. Box 106, Lilongwe, Malawi.
| | - Charlotte C Heuvelings
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD, Amsterdam, the Netherlands.
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Prajapati R, Kumar A, Sharma P, Singla V, Bansal N, Dhawan S, Arora A. A Rare Presentation of Leishmaniasis. J Clin Exp Hepatol 2016; 6:146-8. [PMID: 27493461 PMCID: PMC4963322 DOI: 10.1016/j.jceh.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/06/2016] [Indexed: 12/12/2022] Open
Abstract
Leishmaniasis or kala-azar is a protozoan disease that can present as cutaneous, mucocutaneous, visceral, and disseminated disease. In India, it is usually localized in distinct areas of Bihar, Jharkhand, West Bengal, and parts of Eastern Uttar Pradesh. Visceral leishmaniasis (VL) involves the visceral organs, mainly the liver, the spleen and bone marrow. VL is characterized by prolonged fever, massive splenomegaly, weight loss, progressive anemia, pancytopenia, and hypergammaglobulinemia, and can be complicated by serious infections. In most of the patient the diagnosis is made on bone marrow biopsy or splenic aspirate. We hereby present an unusual case of kala-azar in a 52-year-old patient non-resident of endemic area presenting with pyrexia of unknown origin, in whom bone marrow biopsy was negative for Leishmanin Donovan (LD) bodies, and diagnosis was made by liver biopsy in which LD bodies were seen.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- ANA, anti-nuclear antibodies
- AST, aspartate aminotransferase
- CT, computerized tomography
- E, eosinophils
- ESR, erythrocyte sedimentation rate
- GGT, gamma glutamyl transferase
- HBsAg, hepatitis B surface antigen
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- L, lymphocytes
- LD, Leishmanin Donovan
- Leishmanin Donovan bodies
- P, polymorphs
- PET, positron emission tomography
- PUO, pyrexia of unknown origin
- VL, visceral leishmaniasis
- WBC, white blood count
- kala-azar
- protozoan disease
- pyrexia of unknown origin
- visceral leishmaniasis
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Affiliation(s)
- Ritesh Prajapati
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India,Address for correspondence: Dr. Ashish Kumar, Associate Professor, Department of Gastroenterology & Hepatology, Ganga Ram Institute of Postgraduate Medical Education & Research (GRIPMER), Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110 060, India. Tel.: +91 9312792573; fax: +91 11 25861002.
| | - Praveen Sharma
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vikas Singla
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Naresh Bansal
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Shashi Dhawan
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
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Cobo F, Aliaga L, Talavera P, Concha Á. The histological spectrum of non-granulomatous localized mucosal leishmaniasis caused byLeishmania infantum. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 101:689-94. [DOI: 10.1179/136485907x229095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Pantanowitz L, Leiman G, Garcia LS. Microbiology. CYTOPATHOLOGY OF INFECTIOUS DISEASES 2011. [PMCID: PMC7121403 DOI: 10.1007/978-1-4614-0242-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In order to render an accurate diagnosis, and correctly identify clinically important microorganisms, a good understanding and knowledge of microbiology is essential. This chapter provides a broad overview of microbiology that is relevant to the practicing cytologist. Virology addresses the cytopathic effects caused by viruses and discusses many key infections. Bacteriology covers important bacterial causes of infection including those due to mycobacteria and filamentous bacteria. Mycology deals with common fungi as well as deep mycoses, particularly those caused by invasive and dimorphic fungal organisms. Parasitology highlights the protozoa, apicomplexans, and helminths likely to be seen in cytology samples. Algae are also briefly mentioned.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, 5150 Centre Avenue, Suite 201, Pittsburgh, PA 15232 USA
| | - Gladwyn Leiman
- Fletcher Allen Health Care, University of Vermont, Burlington, VT USA
| | - Lynne S. Garcia
- LSG & Associates, 512-12th Street, Santa Monica, CA 90402 USA
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Khanlari B, Bodmer M, Terracciano L, Heim MH, Fluckiger U, Weisser M. Hepatitis with Fibrin-Ring Granulomas. Infection 2007; 36:381-3. [DOI: 10.1007/s15010-007-6365-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 04/24/2007] [Indexed: 10/22/2022]
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Abstract
AIM To determine whether liver biopsy might be useful in the diagnosis of visceral leishmaniasis when bone marrow examination and serologic tests are inconclusive. METHODS Over a 10-year period, liver biopsy was performed in five children with suspected visceral leishmaniasis when indirect hemagglutination tests and bone marrow aspirations were not diagnostic. RESULTS Leishmania amastigotes were seen in Kupffer cells in all patients. The accompanying liver histopathological findings were ischemic necrosis in two children, macrovesicular steatosis in two children, portal inflammatory inflammation in two children, and piecemeal necrosis in one child. During the study period, 32 additional pediatric visceral leishmaniasis cases were diagnosed by bone marrow examination. CONCLUSION Liver biopsy can be recommended for diagnosing suspected visceral leishmaniasis in children when serology and bone marrow aspiration are inconclusive.
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Affiliation(s)
- Reha Artan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Akdeniz University School of Medicine, Antalya, Turkey.
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Rallis T, Day MJ, Saridomichelakis MN, Adamama-Moraitou KK, Papazoglou L, Fytianou A, Koutinas AF. Chronic hepatitis associated with canine leishmaniosis (Leishmania infantum): a clinicopathological study of 26 cases. J Comp Pathol 2005; 132:145-52. [PMID: 15737341 DOI: 10.1016/j.jcpa.2004.09.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Accepted: 09/20/2004] [Indexed: 11/30/2022]
Abstract
Hepatic tissue samples were obtained from 26 dogs humanely destroyed because of naturally occurring leishmaniosis (Leishmania infantum). None of the animals had palpable hepatomegaly or any other physical finding or historical evidence indicative of liver failure. However, serum biochemistry revealed hypoalbuminaemia (6/26), increased alkaline phosphatase (ALP) activity (15/26), and increased concentrations of total bilirubin (2/26) and post-prandial bile acids (4/26). Three main histological patterns were identified. In pattern 1 (3/26), the liver microarchitecture remained unchanged apart from the presence of individual or clustered macrophages in the sinusoids. In pattern 2 (20/26), there was multifocal, mild to moderate, granulomatous to pyogranulomatous infiltration of the hepatic parenchyma, particularly in the portal areas. Pattern 3 (3/26), which was the most severe form, was characterized by marked portal lymphoplasmacytic infiltration with occasional broaching of the limiting plate and extension into the adjacent parenchyma. In this pattern there was also mild portal fibrosis, together with lymphoplasmacytic aggregates within the parenchyma and small clusters of lymphocytes and plasma cells within the sinusoids. All three patterns were associated with hepatocyte vacuolation (15/26 dogs), and haemosiderin accumulation within the hepatocyte cytoplasm. Congestion was present in the liver of five dogs. No correlation was found between histopathological pattern and breed, sex, age, clinical manifestations, serum biochemical profile or parasite load in the hepatic tissue; patterns 1-3 may, however, represent sequential stages of hepatic leishmania infection during the chronic course of the disease.
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Affiliation(s)
- T Rallis
- Clinic of Companion Animal Medicine, School of Veterinary Medicine, Aristotle University of Thessaloniki, Stavrou Voutyra 11, GR-54627, Thessaloniki, Greece
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Abstract
From the early 1900s, visceral leishmaniasis (VL; kala-azar) has been among the most important health problems in Sudan, particularly in the main endemic area in the eastern and central regions. Several major epidemics have occurred, the most recent--in Western Upper Nile province in southern Sudan, detected in 1988--claiming over 100,000 lives. The disease spread to other areas that were previously not known to be endemic for VL. A major upsurge in the number of cases was noted in the endemic area. These events triggered renewed interest in the disease. Epidemiological and entomological studies confirmed Phlebotomus orientalis as the vector in several parts of the country, typically associated with Acacia seyal and Balanites aegyptiaca vegetation. Infection rates with Leishmania were high, but subject to seasonal variation, as were the numbers of sand flies. Parasites isolated from humans and sand flies belonged to three zymodemes (MON-18, MON-30 and MON-82), which all belong to the L. donovani sensu lato cluster. Transmission dynamics have not been elucidated fully; heavy transmission in relatively scarcely populated areas such as Dinder national park suggested zoonotic transmission whereas the large numbers of patients with post kala-azar dermal leishmaniasis (PKDL) in heavily affected villages may indicate a human reservoir and anthroponotic transmission. Clinical presentation in adults and in children did not differ significantly, except that children were more anaemic. Fever, weight loss, hepato-splenomegaly and lymphadenopathy were the most common findings. PKDL was much more common than expected (56% of patients with VL developed PKDL), but other post-VL manifestations were also found affecting the eyes (uveitis, conjunctivitis, blepharitis), nasal and/or oral mucosa. Evaluation of diagnostic methods showed that parasitological diagnosis should still be the mainstay in diagnosis, with sensitivities for lymph node, bone marrow and spleen aspirates of 58%, 70% and 96%, respectively. Simple, cheap serological tests are needed. The direct agglutination test (DAT) had a sensitivity of 72%, specificity of 94%, positive predictive value of 78% and negative predictive value of 92%. As with other serological tests, the DAT cannot distinguish between active disease, subclinical infection or past infection. The introduction of freeze-dried antigen and control sera greatly improved the practicality and accuracy of the DAT in the field. An enzyme-linked immunosorbent assay using recombinant K39 antigen had higher sensitivity than DAT (93%). The polymerase chain reaction using peripheral blood gave a sensitivity of 70-93% and was more sensitive than microscopy of lymph node or bone marrow aspirates in patients with suspected VL. The leishmanin skin test (LST) was typically negative during active VL and converted to positive in c. 80% of patients 6 months after treatment. Immunological studies showed that both Th1 and Th2 cell responses could be demonstrated in lymph nodes from VL patients as evidenced by the presence of messenger ribonucleic acid for interleukin (IL)-10, interferon gamma and IL-2. Treatment of peripheral blood mononuclear cells from VL patients with IL-12 was found to drive the immune response toward a Th1 type response with the production of interferon gamma, indicating a potential therapeutic role for IL-12. VL responded well to treatment with sodium stibogluconate, which is still the first line drug at a dose of 20 mg/kg intravenously or intramuscularly per day for 15-30 d. Side effects and resistance were rare. Liposomal amphotericin B was effective, with few side effects. Control measures have not been implemented. Based on observations that VL does not occur in individuals who have a positive LST, probably because of previous cutaneous leishmaniasis, a vaccine containing heat-killed L. major promastigotes is currently undergoing a phase III trial.
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Affiliation(s)
- E E Zijlstra
- Department of Epidemiology and Clinical Sciences, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan.
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Koshy A, Al-Azmi WM, Narayanan S, Grover S, Hira PR, Idris M, Madda JP. Leishmaniasis diagnosed by liver biopsy: management of two atypical cases. J Clin Gastroenterol 2001; 32:266-7. [PMID: 11246361 DOI: 10.1097/00004836-200103000-00021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Two patients presenting with pyrexia of unknown origin were diagnosed as having visceral leishmaniasis based on the presence of Leishmania donovani bodies in liver tissue. Of particular interest is that these two case reports suggest that in patients with pyrexia of unknown origin, a liver biopsy for L. donovani bodies should be considered even when several months have passed since leaving an endemic area, when splenomegaly is absent, when bone marrow examination and serology are not diagnostic, and even when abnormal coagulation necessitates a transjugular liver biopsy.
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Affiliation(s)
- A Koshy
- Faculty of Medicine, Kuwait University.
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Abstract
Lingual thyroid is a rare developmental disorder and is more frequent in women. The pathogenesis is unclear but may be related to the presence of maternal blocking autoantibodies against the thyroid. Treatment of this disorder includes the use of levothyroxine in order to correct the hypothyroidism, which is very frequent and to induce the shrinkage of the gland. When symptoms of obstruction or bleeding appear, ablative therapy by means of surgery or radioiodine is warranted. We report three cases and discuss the approach to diagnosis and a strategy for management.
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Affiliation(s)
- P Arancibia
- Department of Medicine, Hospital del Salvador, University of Chile School of Medicine, Santiago
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