A case of Leishmania infantum reported in NEJM

A case of Leishmania infantum has been reported by Dr Giuseppe G. Loscocco, at the University of Florence, Florence, Italy and colleagues and has appeared in NEJM.

Visceral leishmaniasis is the second largest parasitic killer in the world. Also known as kala-azar, it is a group of diseases caused by protozoan parasites from more than 20 Leishmania species. It is characterized by irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anaemia (which may be serious). If untreated, the fatality rate in developing countries can be as high as 100% within 2 years.

According to history, a 49-year-old previously healthy man presented to the emergency department with a 5-month history of fever, abdominal pain, fatigue, and an unintentional 15-kg weight loss. The physical examination was notable for an enlarged liver and spleen. Laboratory studies showed a white-cell count of 2040 per cubic millimetre (reference range, 4000 to 10,000), a haemoglobin level of 9.2 g per deciliter (reference range, 14.0 to 18.0), and a platelet count of 50,000 per cubic millimetre (reference range, 140,000 to 400,000).

Blood cultures, as well as tests for human immunodeficiency virus, hepatitis B virus, hepatitis C virus, cytomegalovirus, and Epstein–Barr virus, were negative. Computed tomography of the abdomen confirmed the presence of an enlarged liver and a markedly enlarged spleen. The examination of a bone marrow aspirate revealed amastigotes, each with a nucleus and a kinetoplast, within histiocytes.

Courtesy NEJM

This is the typical appearance of leishmaniasis, and polymerase-chain-reaction testing of the bone marrow aspirate confirmed the diagnosis. Transmitted by sandflies, Leishmania infantum is endemic to Italy and the Mediterranean region. The patient started treatment with liposomal amphotericin B. At a follow-up visit 1 month later, the fever, abdominal pain, and fatigue had resolved, and physical examination revealed resolution of the splenomegaly.

For more details click on the link: DOI: 10.1056/NEJMicm1803648