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Mangaonkar AA, Tande AJ, Bekele DI. Differential Diagnosis and Workup of Monocytosis: A Systematic Approach to a Common Hematologic Finding. Curr Hematol Malig Rep 2021; 16:267-275. [PMID: 33880680 PMCID: PMC8057007 DOI: 10.1007/s11899-021-00618-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/19/2022]
Abstract
Purpose of Review Monocytosis is a frequently encountered clinical condition that needs appropriate investigation due to a broad range of differential diagnoses. This review is meant to summarize the latest literature in the diagnostic testing and interpretation and offer a stepwise diagnostic approach for a patient presenting with monocytosis. Recent Findings Basic studies have highlighted the phenotypic and functional heterogeneity in the monocyte compartment. Studies, both translational and clinical, have provided insights into why monocytosis occurs and how to distinguish the different etiologies. Flow cytometry studies have illustrated that monocyte repartitioning can distinguish chronic myelomonocytic leukemia, a prototypical neoplasm with monocytosis from other reactive or neoplastic causes. Summary In summary, we provide an algorithmic approach to the diagnosis of a patient presenting with monocytosis and expect this document to serve as a reference guide for clinicians.
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Affiliation(s)
| | - Aaron J Tande
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Delamo I Bekele
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Brovko MI, Akulkina LA, Potapov PP, Sholomova VI, Lebedeva MV, Nekrasova TP, Varshavskii VA, Volchkova EV, Rozina TP, Nikulkina EN, Karan LS, Moiseev SV, Fomin VV. [Visceral leishmaniasis: a challenging diagnosis in internal medicine]. TERAPEVT ARKH 2020; 92:117-121. [PMID: 33720616 DOI: 10.26442/00403660.2020.11.000619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/26/2020] [Indexed: 11/22/2022]
Abstract
Leishmaniasis is a vector-born parasitic disease characterized by predominant cutaneous or visceral involvement with fever, hepatosplenomegaly and anemia. Leishmaniasis has relatively high prevalence in tropical and subtropical areas. Several sporadic and mostly imported cases are detected in Russian Federation. Nevertheless, some local incidents are noted in southern areas (Crimea, Dagestan). Lack of epidemiological alertness hampers confirmation of diagnosis and may lead to incorrect treatment. The article summarizes current state of knowledge in epidemiology, diagnostic approach and treatment of leishmaniasis. Particular clinical case is discussed.
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Affiliation(s)
- M I Brovko
- Sechenov First Moscow State Medical University (Sechenov University)
| | - L A Akulkina
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - V I Sholomova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M V Lebedeva
- Sechenov First Moscow State Medical University (Sechenov University)
| | - T P Nekrasova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V A Varshavskii
- Sechenov First Moscow State Medical University (Sechenov University)
| | - E V Volchkova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - T P Rozina
- Sechenov First Moscow State Medical University (Sechenov University).,Lomonosov Moscow State University
| | - E N Nikulkina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - L S Karan
- Central Research Institute of Epidemiology
| | - S V Moiseev
- Sechenov First Moscow State Medical University (Sechenov University).,Lomonosov Moscow State University
| | - V V Fomin
- Sechenov First Moscow State Medical University (Sechenov University)
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Kalmi G, Vignon-Pennamen MD, Ram-Wolff C, Battistella M, Lafaurie M, Bouaziz JD, Hamane S, Bernard S, Bretagne S, Thiéblemont C, Bagot M, de Masson A. Visceral leishmaniasis in patients with lymphoma: Case reports and review of the literature. Medicine (Baltimore) 2020; 99:e22787. [PMID: 33157924 PMCID: PMC7647553 DOI: 10.1097/md.0000000000022787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Non-HIV-related visceral leishmaniasis (VL) is becoming increasingly prevalent in nontropical countries because of the increasing number of patients with chronic diseases and the development of immune-modulating drugs. PATIENT CONCERNS Case 1 is a 60-year-old male patient of Senegalese origin presented with weight loss, lymphadenopathy, anemia, and elevated lactate dehydrogenases. Case 2 is a 46-year-old male patient of Algerian origin, with a negative HIV serology presented with cutaneous lesions. DIAGNOSIS Patient 1: The diagnosis of stage IV lymphocytic lymphoma (LL) was confirmed by an inguinal nodal biopsy in 2013. Patient 2: The diagnosis of T-cell lymphoma was made in 2003. INTERVENTIONS Patient 1 received 5 cycles of bendamustine and rituximab followed by a complete remission. Patient 2 was initially treated with >10 different treatments followed by 8 different chemotherapy regimens due to the disease progression. OUTCOMES Patient 1: In 2017, after a follow-up of 4 years, the patient presented with fever, lymphadenopathy, splenomegaly, and pancytopenia in the setting of hemophagocytic syndrome. The initial diagnosis was a relapse of lymphoma and the patient was treated with ibrutinib. His status worsened, and Leishmania DNA was detected by polymerase chain reaction (PCR) on the blood and bone marrow aspirates. Ibrutinib was stopped. Amphotericin B treatment induced a complete clinical remission and clearance of Leishmania DNA from the blood.Patient 2: In 2017, after a follow-up of 14 years, the patient presented with fever, lymphadenopathy, hepatosplenomegaly, pancytopenia with hemophagocytic syndrome, and an increase in the tumor skin lesions. A skin biopsy was taken from the face and the patient. A careful reexamination of the skin biopsy revealed the presence of Leishmania bodies. He was treated with 40 mg/kg liposomal amphotericin B leading to a regression of the clinical symptoms and negativation of the blood PCR. CONCLUSIONS This case study shows that VL may be a diagnostic challenge in patients with lymphoma. Reactivation or primary infection should be considered in the differential diagnosis. The purpose of this study is to remind clinicians to think of VL in patients with systemic symptoms that could be misdiagnosed as a progression of the underlying lymphoma.
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MESH Headings
- Diagnosis, Differential
- Disease Progression
- Humans
- Leishmaniasis, Visceral/complications
- Leishmaniasis, Visceral/diagnosis
- Leishmaniasis, Visceral/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Middle Aged
- Remission Induction
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Affiliation(s)
- Galith Kalmi
- Service de Dermatologie, APHP, Hôpital Saint Louis
- INSERM U976
| | | | | | | | | | - Jean-David Bouaziz
- Service de Dermatologie, APHP, Hôpital Saint Louis
- INSERM U976
- Université de Paris
| | - Samia Hamane
- Laboratoire de Parasitologie, APHP, Hôpital Saint Louis
| | - Sophie Bernard
- Université de Paris
- Service d’Hémato-oncologie, APHP, Hôpital Saint Louis, Paris, France
| | - Stéphane Bretagne
- Laboratoire de Parasitologie, APHP, Hôpital Saint Louis
- Université de Paris
| | - Catherine Thiéblemont
- Université de Paris
- Service d’Hémato-oncologie, APHP, Hôpital Saint Louis, Paris, France
| | - Martine Bagot
- Service de Dermatologie, APHP, Hôpital Saint Louis
- INSERM U976
- Université de Paris
| | - Adèle de Masson
- Service de Dermatologie, APHP, Hôpital Saint Louis
- INSERM U976
- Université de Paris
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Schwing A, Pomares C, Majoor A, Boyer L, Marty P, Michel G. Leishmania infection: Misdiagnosis as cancer and tumor-promoting potential. Acta Trop 2019; 197:104855. [PMID: 30529443 DOI: 10.1016/j.actatropica.2018.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 12/17/2022]
Abstract
Given the prevalence of cancer and leishmaniasis worldwide, the presence of these two pathologies in the same tissue sample may be merely fortuitous. The clinical outcome of both diseases is under the control of innate and adaptive immunity, and in both cases these progressive diseases are characterized by an impaired host Th1 response. As a consequence, the Th2 cytokine microenvironment occurring in progressive leishmaniasis may potentially promote tumor cell proliferation and vice versa. On the other hand, clinical aspects of subclinical cutaneous or visceral leishmaniasis sometimes closely resemble those observed in various neoplasms thus leading to misdiagnosis. In this review, we present recent findings on the association between leishmaniasis and malignant disorders. Our review includes HIV positive, HIV negative subjects and patients whose HIV status has not been established. Leishmaniasis mimicking a malignant disorder was confirmed and extended to unreported neoplastic disorders including squamous cell carcinoma, T-cell and B-cell lymphoma, oral and intranasal tumors and granulomas. Thus, leishmaniasis should be considered in the differential diagnosis and course of various cancers in Leishmania endemic areas or in patients with travel history to these areas. We also listed recent reports showing that Leishmania can promote cancer development in immunocompromised as well as in immunocompetent patients. The potential mechanisms supporting this promoting effect are discussed.
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Heydarpour F, Sari AA, Mohebali M, Shirzadi M, Bokaie S. Incidence and Disability-Adjusted Life Years (Dalys) Attributable to Leishmaniasis In Iran, 2013. Ethiop J Health Sci 2017; 26:381-8. [PMID: 27587936 PMCID: PMC4992778 DOI: 10.4314/ejhs.v26i4.10] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Leishmaniasis covers a range of clinical manifestations. Estimation of the burden of leishmaniasis may help guide healthcare management personnel and policy-makers in applying effective interventions. The present study aimed to calculate the incidence and burden of cutaneous and visceral leishmaniasis in Iran in 2013. Methods To evaluate the epidemiological aspects of the disease in Iran, published studies over the past 20 years were searched and the viewpoints of relevant specialists in Iran were obtained. Data were collected from the Ministry of Health and from the Tehran University of Medical Sciences. To calculate years of life lost due to premature death, standard expected years of life lost was used. Standard life table of Global Burden of Disease (GBD) 2010 with the life expectancy of 86.02 years for both sexes was used to calculate the remaining potential years of life at any age from death. Results The overall incidence of cutaneous and visceral leishmaniasis was calculated as 22 and 0.092 per 100000 population of Iran, respectively. The burden of leishmaniasis was 99.5 years: 95.34 and 4.16 years for cutaneous and visceral, respectively. Sensitivity was analyzed and deaths predicted by the Institute of Health Metrics and Evaluation added, the burden of visceral leishmaniasis was 726 years. Conclusion The share of leishmaniasis burden in Iran is lower than the global burden of the disease. GBD 2010 standard method is recommended to calculate the burden of leishmaniasis in different countries and set local priorities on the basis of these measures.
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Affiliation(s)
- Fatemeh Heydarpour
- Department of Epidemiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Ppublic Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shirzadi
- Department of Zoonoses, Communicable Disease Management Center, Ministry of Health, treatment and Education, Tehran, Iran
| | - Saied Bokaie
- Department of Epidemiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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Gobbi F, Martelli G, Attard L, Buonfrate D, Angheben A, Marchese V, Bortesi L, Gobbo M, Vanino E, Viale P, Bisoffi Z. Schistosoma mansoni Eggs in Spleen and Lungs, Mimicking Other Diseases. PLoS Negl Trop Dis 2015. [PMID: 26204263 PMCID: PMC4512674 DOI: 10.1371/journal.pntd.0003860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Federico Gobbi
- Center for Tropical Diseases, Ospedale Sacro-Cuore Don Calabria, Negrar, Verona, Italy
- * E-mail:
| | - Giulia Martelli
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Ospedale S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luciano Attard
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Ospedale S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Dora Buonfrate
- Center for Tropical Diseases, Ospedale Sacro-Cuore Don Calabria, Negrar, Verona, Italy
| | - Andrea Angheben
- Center for Tropical Diseases, Ospedale Sacro-Cuore Don Calabria, Negrar, Verona, Italy
| | - Valentina Marchese
- Center for Tropical Diseases, Ospedale Sacro-Cuore Don Calabria, Negrar, Verona, Italy
- Acute and Chronic Viral Hepatitis Department, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Laura Bortesi
- Department of Pathology, Ospedale Sacro-Cuore Don Calabria, Negrar, Verona, Italy
| | - Maria Gobbo
- Center for Tropical Diseases, Ospedale Sacro-Cuore Don Calabria, Negrar, Verona, Italy
| | - Elisa Vanino
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Ospedale S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Ospedale S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Zeno Bisoffi
- Center for Tropical Diseases, Ospedale Sacro-Cuore Don Calabria, Negrar, Verona, Italy
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van Griensven J, Carrillo E, López-Vélez R, Lynen L, Moreno J. Leishmaniasis in immunosuppressed individuals. Clin Microbiol Infect 2014; 20:286-99. [DOI: 10.1111/1469-0691.12556] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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8
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The hematopathologist as detective. J Hematop 2011. [DOI: 10.1007/s12308-011-0098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Fakhar M, Banimostafavi E, Motazedian MH, Asgari Q. Co-infection of Leishmania infantum and Brucella spp in Iran. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s00580-008-0749-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Mediterranean visceral leishmaniasis associated with acute lymphoblastic leukemia (ALL). Parasitol Res 2008; 103:473-5. [DOI: 10.1007/s00436-008-0999-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 04/10/2008] [Indexed: 11/27/2022]
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Kopterides P, Mourtzoukou EG, Skopelitis E, Tsavaris N, Falagas ME. Aspects of the association between leishmaniasis and malignant disorders. Trans R Soc Trop Med Hyg 2007; 101:1181-9. [PMID: 17870139 DOI: 10.1016/j.trstmh.2007.08.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 08/06/2007] [Accepted: 08/06/2007] [Indexed: 11/15/2022] Open
Abstract
Given the prevalence of leishmaniasis and cancer, the co-existence of these two diseases may be merely coincidental. However, a number of epidemiological, experimental and laboratory studies suggest that an association between these two entities does exist. The aim of this review is to summarise the occurrence of leishmaniasis as an opportunistic infection associated with malignant disorders and to present the available literature potentially linking this infection with the development of cancerous lesions. We searched electronic databases and evaluated 37 studies involving 44 patients. Four different types of association between leishmaniasis and cancer were established: leishmaniasis mimicking a malignant disorder, such as lymphoma; leishmaniasis arising as a difficult to diagnose and treat infection among patients receiving chemotherapy for various malignant disorders; simultaneous diagnosis of leishmaniasis and a neoplastic disorder in the same tissue samples of immunocompromised patients; and direct involvement of Leishmania spp. in the pathogenesis/occurrence of malignant lesions, especially of the skin and mucous membranes. The main conclusion of this review is that leishmaniasis can directly or indirectly affect the presentation, diagnosis and course of various malignant disorders and it should be considered in the differential diagnosis of malignancies in geographic areas where it is endemic and/or in patients with travel history to these areas.
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Affiliation(s)
- Petros Kopterides
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Department of Pathophysiology, Oncology Unit, Laiko General Hospital, University of Athens, School of Medicine, Athens, Greece
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Yavuzer R, Akyürek N, Ozmen S, Demirtaş Y, Ataoğlu O. Leishmania cutis with B-cell cutaneous hyperplasia. Plast Reconstr Surg 2001; 108:2177-8. [PMID: 11743447 DOI: 10.1097/00006534-200112000-00087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Compromised travelers represent a diverse and challenging group of individuals. They include HIV-infected patients who are at risk for potentially adverse reactions to immunizations, and new exposures to enteric water-borne opportunistic pathogens associated with chronic infections. Such travelers may encounter unfamiliar opportunistic fungi and classical tropical infections, such as leishmaniasis, whose pathogenesis can be enhanced by the presence of prior HIV infection. Other immunocompromised groups include those who are functionally or anatomically asplenic, and patients who are iatrogenically immunosuppressed from medications utilized for solid organ transplantation, chemotherapy, or treatment of malignancies. This population of travelers also includes those with diabetes mellitus who may require adjustments in their dosing, administration, and possibly even the types of insulin used on their trips. These patients are also at greater risk for acquisition of tuberculosis, severe community-acquired pneumonia, urinary tract infections, and pyomyositis. Older travelers present both the infectious disease and travel medicine specialist with issues such events, malignancy-related infections, myocardial infarction, and other forms of cardiopulmonary compromise, which the authors address in this article.
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Affiliation(s)
- M D Mileno
- Department of Medicine, Brown University, Providence, Rhode Island, USA
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Abstract
The most important cause of fever in the returned traveler is malaria. All febrile patients in which malaria is epidemiologically possible require urgent evaluation for P. falciparum malaria, which can be rapidly fatal in the nonimmune patient. Early diagnosis and therapy can prevent severe morbidity and mortality. Other less common causes of undifferentiated fever include acute schistosomiasis, the enteric fevers, rickettsial diseases, leptospirosis, and dengue fever. Early empiric therapy for suspected leptospirosis and the rickettsial infections is encouraged to decrease morbidity and mortality. About a quarter of febrile patients do not have an etiologic agent determined for their illness but recover without sequelae. Patients with fever and hemorrhagic manifestations within 3 weeks of their return need to be isolated for the remote possibility of a highly transmissible agent. Although the febrile traveler is always a challenge, the real world differential diagnosis is limited and a systematic approach via the history, physical examination, and selected laboratory tests is usually sufficient to confirm the diagnosis or eliminate potentially serious infections.
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Affiliation(s)
- A J Magill
- United States Naval Medical Research Institute Detachment (US NAMRID), Lima, Peru
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