FROM UNEXPLAINED FEVER TO VISCERAL LEISHMANIASIS – A CASE REPORT
Autori:
Ivan Marković, Ana Gudelj-Gračanin, Melanie-Ivana Čulo, Tajana Štoos-Veić, Ninoslava Vicković, Boško Desnica, Jadranka Morović-Vergles
Sažetak
Visceralna lišmenijaza ili kala-azar sustavna je infektivna bolest uzrokovana protozoama Leishmania donovani i Leishmania infantum koje prenose zaraženi insekti poznati kao nevidi ili papatači. Javlja se u endemskim područjima, uglavnom sporadično, a u Europi je prisutna na prostoru uz Sredozemno more. U Hrvatskoj se žarišta infekcije nalaze u južnim priobalnim područjima gdje su psi glavni izvor zaraze za ljude. Bolest se očituje dugotrajnim vrućicama, općom slabošću, hepatosplenomegalijom, pancitopenijom, albuminsko-globulinskom inverzijom. Izostanak liječenja većinom dovodi do smrtnog ishoda. U radu smo prikazali bolesnika iz Hrvatske koji je hospitaliziran zbog dugotrajne vrućice nepoznata uzroka u kojega smo dva mjeseca od pojave prvih simptoma na osnovi pregleda punktata koštane srži uz serološke testove dijagnosticirali visceralnu lišmenijazu. Diferencijalnodijagnostički pomišljali smo i na sekundarnu hemofagocitnu limfohistiocitozu. Nakon četverotjednog liječenja natrijevim stiboglukonatom došlo je do kliničke remisije uz potpuni oporavak hematopoeze. Prikazali smo svog bolesnika kako bismo upozorili na važnost pomišljanja i na visceralnu lišmenijazu u dugotrajnim vrućicama.
Summary
Visceral leishmaniasis or kala-azar is a systemic infectious vector-borne disease caused by protozoa Leishmania donovani and Leishmania infantum that are transmitted to mammalian hosts by sand flies. It occurrs sporadically in endemic areas, including Mediterranean basin. Southern coastal territories of Croatia have been recognized as the foci of the disease. Dogs are the main reservoir of human infection. Clinical features include prolonged fever, malaise, hepatosplenomegaly, pancytopenia and inversion of albumin-globulin ratio. If left untreated, the disease causes death in majority of cases. We report a 47-year-old Croatian patient who was admitted to hospital with 2-month history of fever of unknown origin. Based on bone marrow aspirate findings and positive serological tests, the diagnosis of visceral leishmaniasis was established. We also considered secondary hemophagocytic lymphohystiocytosis in the differential diagnosis. After a 4-week treatment with sodium-stibogluconate clinical remission was achieved as well as complete recovery of hematopoesis. The aim of our case-report is to stress the importance of considering visceral leishmaniasis in patients with long-standing fever in endemic areas.
