1
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Affiliation(s)
- Michael D Gibbons
- From the Department of Medicine, Newton-Wellesley Hospital, Newton (M.D.G.), and the Departments of Radiology (D.P.M.), Medicine (A.W., M.B.B.), and Pathology (J.A.V.), Massachusetts General Hospital, and the Departments of Radiology (D.P.M.), Medicine (A.W., M.B.B.), and Pathology (J.A.V.), Harvard Medical School, Boston - all in Massachusetts
| | - Dexter P Mendoza
- From the Department of Medicine, Newton-Wellesley Hospital, Newton (M.D.G.), and the Departments of Radiology (D.P.M.), Medicine (A.W., M.B.B.), and Pathology (J.A.V.), Massachusetts General Hospital, and the Departments of Radiology (D.P.M.), Medicine (A.W., M.B.B.), and Pathology (J.A.V.), Harvard Medical School, Boston - all in Massachusetts
| | - Anem Waheed
- From the Department of Medicine, Newton-Wellesley Hospital, Newton (M.D.G.), and the Departments of Radiology (D.P.M.), Medicine (A.W., M.B.B.), and Pathology (J.A.V.), Massachusetts General Hospital, and the Departments of Radiology (D.P.M.), Medicine (A.W., M.B.B.), and Pathology (J.A.V.), Harvard Medical School, Boston - all in Massachusetts
| | - Miriam B Barshak
- From the Department of Medicine, Newton-Wellesley Hospital, Newton (M.D.G.), and the Departments of Radiology (D.P.M.), Medicine (A.W., M.B.B.), and Pathology (J.A.V.), Massachusetts General Hospital, and the Departments of Radiology (D.P.M.), Medicine (A.W., M.B.B.), and Pathology (J.A.V.), Harvard Medical School, Boston - all in Massachusetts
| | - Julian A Villalba
- From the Department of Medicine, Newton-Wellesley Hospital, Newton (M.D.G.), and the Departments of Radiology (D.P.M.), Medicine (A.W., M.B.B.), and Pathology (J.A.V.), Massachusetts General Hospital, and the Departments of Radiology (D.P.M.), Medicine (A.W., M.B.B.), and Pathology (J.A.V.), Harvard Medical School, Boston - all in Massachusetts
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2
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Clavijo Sánchez F, Vázquez Sánchez T, Cabello Díaz M, Sola Moyano VE, Jironada Gallego C, Hernández Marrero D. Visceral Leishmaniasis in Renal Transplant Recipients: Report of 2 Cases. Transplant Proc 2018; 50:581-582. [PMID: 29579858 DOI: 10.1016/j.transproceed.2017.12.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/02/2017] [Accepted: 12/04/2017] [Indexed: 11/17/2022]
Abstract
Visceral leishmaniasis is a disease caused by the protozoan Leishmania and is transmitted by Lutzomyia longipalpis (sand fly). It is an endemic parasitic infection in numerous areas around the Mediterranean basin. Though immunocompetent patients may not develop the disease, in transplant recipients the use of corticoids and intensified immunosuppressants to prevent graft rejection may accelerate the disease, causing severe damage to the liver, spleen, and hematopoietic system. We report 2 cases of visceral leishmaniasis with an atypical presentation in transplant recipients. The first patient, who had a kidney transplant, was treated successfully with liposomal amphotericin B, and the second patient, a combined kidney-pancreas transplant recipient, suffered a relapse 3 years after treatment. Visceral leishmaniasis should be considered in the differential diagnosis of pancytopenia or unexplained fever occurring after organ transplantation in patients living in endemic areas or returning from endemic countries.
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Affiliation(s)
- F Clavijo Sánchez
- Nephrology Department, Torrecárdenas Hospital Complex, Almería, Spain.
| | - T Vázquez Sánchez
- Nephrology Department, Regional University Hospital of Málaga, Málaga, Spain
| | - M Cabello Díaz
- Nephrology Department, Regional University Hospital of Málaga, Málaga, Spain
| | - V E Sola Moyano
- Nephrology Department, Regional University Hospital of Málaga, Málaga, Spain
| | - C Jironada Gallego
- Nephrology Department, Regional University Hospital of Málaga, Málaga, Spain
| | - D Hernández Marrero
- Nephrology Department, Regional University Hospital of Málaga, Málaga, Spain
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3
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Singh A, Kumari S. Filariasis Presenting As Bone Marrow Suppression. J Ayub Med Coll Abbottabad 2016; 28:609-610. [PMID: 28712247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Lymphatic filariasis is caused by most commonly Wuchereria bancrofti in India. The diagnosis is made by demonstration of microfilariae in the peripheral blood, body fluids, fine needle aspirates and in bronchial brushings. Presence of microfilariae in the bone marrow is unusual and not been reported frequently. We are reporting here a case of a young male who had pancytopenia and was found to have microfilariae in the bone marrow.
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Affiliation(s)
- Anup Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sarita Kumari
- Department of Anaesthesia, Indira Gandhi Institute of Medical Sciences, Patna-India
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4
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Abstract
The study included 57 patients with visceral leishmaniasis. The average duration of symptoms was 3.8 ± 3.55 months and pancytopenia was the commonest haematological abnormality. The parasite load directly correlated with the degree of anaemia at presentation (P=0.03). Splenic regression took 9.58 ±4.5 days and haematological parameters recovered in 14.5±9.07 days. There were five deaths over the five-year study duration. Leishmaniasis was not the first diagnosis in 14 patients, of whom eight were residents of non-endemic regions. Diagnosis was achieved in 13.5 days in these patients, compared to 4.5 days in patients where leishmaniasis was suspected at the outset.
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Affiliation(s)
- A Sud
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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5
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Abstract
We present a case of hyperreactive malarial splenomegaly, a disease which is exceptional in Caucasian people, but which is expected to become more important since the increasing number of travelling to tropical areas. It is the chronic stage of an abnormal long-term stimulation of the immune system secondary to plasmodial infection. Diagnostic criteria include long-term stay in an endemic zone, large splenomegaly and overproduction of both IgM and IgG antibodies. The disease can be treated by a short-term antimalarial therapy as long as the patient resides out of a malarial endemic country.
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Affiliation(s)
- D Masfrancx
- Department of Internal Medicine, University Hospitals Leuven.
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Van de Maele I, Savary-Bataille K, Gielen I, Daminet S. An unusual form of canine babesiosis. Can Vet J 2008; 49:283-286. [PMID: 18390102 PMCID: PMC2249724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
An Akita Inu, living in Belgium, was presented with unusual clinical manifestations of acute babesiosis that included neurological signs and pancytopenia. Diagnosis was made by identifying Babesia canis in the blood smear. Neurological signs resolved after treatment with imidocarb diproprionate. Normalization of hematological abnormalities was gradual over 5 months.
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Affiliation(s)
- Isabel Van de Maele
- Faculty of Veterinary Medicine, Department of Medicine and Clinical Biology of Small Animals, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium.
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7
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Eholié SP, Tanon AK, Folquet-Amorissani M, Doukouré B, Adoubryn KD, Yattara A, Bissagnéné E. [Three new cases of visceral leishmaniasis in Côte d'Ivoire]. Bull Soc Pathol Exot 2008; 101:60-61. [PMID: 18432012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The objective of this work is to report three cases of visceral leishmaniasis in non-HIV infected native patients in Côte d'Ivoire. The three observations concerned adults aged of 31 and 65 and a five years old child without particular medical or surgery histories. Factors associated with visceral leishmaniasis regarding the younger and the older adults were respectively young age, chronic lymphoid leukaemia and Burkitt lymphoma. Clinical features in the three cases were chronic fever a myeloproliferative syndrome with wasting syndrome and pancytopenia. The diagnosis was confirmed by the existence of Leishmania in bone marrow, ganglionic juice and splenic samples. The species of Leishmania was not identified. Specific treatment was based on intravenous amphotericin B (Fungizone) relayed by Glucantim in one case because of side effects; however the treatment has been unsuccessful. These three new cases show that visceral leishmaniasis is a reality in Côte d'Ivoire therefore an epidemiological survey is requested in order to identify Leishmania species, reservoirs and vectors.
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Affiliation(s)
- S P Eholié
- Service des maladies infectieuses et tropicales, BP V 3, CHU Treichville, Abidjan, Côte d'Ivoire
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8
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Meijer MJ, Kuiper-Kramer E, Overbosch D, Groeneveld PHP. Fever from the USA or Portugal? Neth J Med 2005; 63:367. [PMID: 16244386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- M-J Meijer
- Department of Internal Medicine, Isala Clinics, location Sophia, Zwolle, the Netherlands
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Boelaert M, Rijal S, Regmi S, Singh R, Karki B, Jacquet D, Chappuis F, Campino L, Desjeux P, Le Ray D, Koirala S, Van der Stuyft P. A comparative study of the effectiveness of diagnostic tests for visceral leishmaniasis. Am J Trop Med Hyg 2004; 70:72-7. [PMID: 14971701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
We compared the validity of pancytopenia, the formol-gel test (FGT), the indirect fluorescence antibody test (IFAT), the direct agglutination test (DAT), and the rK39 dipstick test as diagnostic criteria for visceral leishmaniasis (VL) in Nepal. Between September 2000 and January 2002, 310 clinical suspects had a bone marrow aspirate, and if negative, a spleen aspirate smear examined for Leishmania donovani. Sensitivity and specificity of all tests were determined compared with parasitology and by latent class analysis (LCA). Compared with parasitology, the sensitivities of the other tests were as follows: pancytopenia = 16.3% (95% confidence interval [CI] = 11.3-22.5%), FGT = 39.9% (95% CI = 32.7-47.4%), IFAT = 28.4% (95% CI = 22.0-35.5%), DAT = 95.1% (95% CI = 90.8-97.7%), and the rK39 dipstick test = 87.4% (95% CI = 81.7-91.9%). Sensitivity estimates obtained by LCA were similar, but specificity estimates were substantially higher (DAT = 93.7% versus 77.8%; rK39 dipstick test = 93.1% versus 77.0%). The DAT or the rK39 dipstick test can replace parasitology as the basis of a decision to treat VL in Nepalese peripheral health services.
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Affiliation(s)
- Marleen Boelaert
- Department of Public Health and Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.
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Affiliation(s)
- R Rajput
- Department of Medicine, Pt B D Sharma Postgraduate Institute of Medicine Sciences, Rohtak, Haryana, India.
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Mégarbane B, Bruneel F, Cazals-Hatem D, Adle-Biassette H, Houze S, Wolff M, Régnier B. [A strange disease of the plateaux. Visceral leishmaniasis]. Rev Med Interne 2001; 22 Suppl 2:219s-222s. [PMID: 11433575 DOI: 10.1016/s0248-8663(01)83653-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- B Mégarbane
- Clinique de réanimation des maladies infectieuses, hôpital Bichat Claude-Bernard, 75018 Paris, France
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12
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Adil SN, Burney IA, Khurshid M. Autoimmune hemolytic anemia in visceral leishmaniasis. J PAK MED ASSOC 1999; 49:100-1. [PMID: 10540540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- S N Adil
- Department of Pathology and Medicine, Aga Khan University Hospital, Karachi
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Büyükaşik Y, Ileri NS, Haznedaroğlu IC, Demiroğlu H, Dündar S. Fever, hepatosplenomegaly and pancytopenia in a patient living in the Mediterranean region. Postgrad Med J 1998; 74:237-9. [PMID: 9683980 PMCID: PMC2360870 DOI: 10.1136/pgmj.74.870.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 24 year old woman living in the Mediterranean region of Turkey present with a three-month history of weight loss and irregular fever that was peaking at 40 degrees C with shivering. No definite aetiology could be identified in a local hospital. A bacterial infection had been suspected, but antibiotic therapy, at first with sulbactam-ampicillin and later with azithromycin, had no influence on the fever. Physical examination revealed an emaciated patient with fever (39 degrees C), pallor, and hepatosplenomegaly (spleen 9 cm and liver 5 cm palpable below the costal margin). No peripheral lymphadenopathy was present. The laboratory examinations are summarised in the table. Notably, a prominent increase of macrophages containing intracellular micro-organisms (figures 1 and 2) was seen in the bone marrow smears. The same micro-organisms were also identified within the Kupffer cells in liver biopsy.
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Affiliation(s)
- Y Büyükaşik
- Department of Adult Haematology, Hacettepe University Medical School, Ankara, Turkey
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14
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Arya TV, Prasad RN. Fatal pancytopenia in falciparum malaria. J Assoc Physicians India 1989; 37:469-70. [PMID: 2693448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Various pernicious syndromes in Plasmodium falciparum infection are being reported with increasing frequency from tropical countries. A rare case of fatal pancytopenia associated with falciparum malaria is described. The patient developed fulminant aspiration bronchopneumonia which was unresponsive to antibiotic therapy and contributed to the development of adult respiratory distress syndrome. He also had severe uncontrolled gastrointestinal bleeding and possibly an intracerebral haemorrhage. Anaemia and thrombocytopenia are well known in malaria but severe leucopenia is very rare and pancytopenia has not been reported.
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