[Hematologic characteristics of leishmaniasis].

BACKGROUND

Leishmaniasis is a chronic infectious disease from the group of anthropozoonoses. It is caused by protozoa in the genus leishmania flagellate. There are five major foci of this disease in the world: India, Mediterranean countries, East Africa, South China and South America. Endemic regions in the Balkans are as follows: Montenegro, Macedonia, Herzegovina and the Morava's valley (1,2). Reservoirs of infection are infected humans and animals (dogs and rodents). Infection is transmitted by insects the most significant representative of which is a sandfly. The course of the disease may be acute, subacute and chronic and several forms are differentiated such as visceral, cutaneous and mucocutaneous. Signs of disease are elevated temperature, gastrointestinal disorders, splenomegaly and hepatomegaly and rarely generalized lymphadenomegaly. Laboratory findings point to pancytopenia. The diagnosis is established on the basis of parasitological findings in macrophages of the bone marrow and is confirmed by serologic tests (4,5). However, mortality is decreased to 5% after the application of 5-valent antimony and amphotericin B (6,7).

METHODS

A female patient aged 19 year from Novi Sad was admitted at the Clinic of Hematology due to unclear febrile state lasting 3 months accompanied by pancytopenia and enlarged spleen. The first discomforts were experienced in the second half of August in 1997 upon the patient's return from Sutomore. The disease started gradually with uncharacteristic manifestations. Firstly, discomforts developed in the region of the gastrointestinal tract and were characterized by loss of appetite, nausea, and vomiting in addition to drastic weight loss. Secondly, fatigue occurred during effort, later on at rest as well, accompanied by increased body temperature. Temperature increased twice a day and was followed by shuddering, fever, shivering and very often by nocturnal sweating. Antibiotics and antipyretics were used, but without fall of temperature. Subjective discomforts were increasingly pronounced, so that due to unclear febrile state and in addition to the present pancytopenia the patient was referred to hospital treatment and was therefore admitted at the Clinic of Hematology. Febrile state, tachycardia, a striking paleness of the skin and visible mucosa as well as splenomegaly were confirmed. Basic laboratory findings (Table 1) pointed to pancytopenia. Apart from anemia and mild thrombocytopenia, leukopenia with neutropenia, lymphocytosis and monocytosis were pronounced. Sternal puncture was the most significant diagnostic procedure on the basis of which the diagnosis was established. In hypocellular bone marrow in macrophages, both intra- and extracellular, protozoa were found in smaller and greater groups which resembled leishmaniasis (Figure 1). The diagnosis was confirmed by serologic tests to leishmaniasis, antibody titre was > 1:32. In order to exclude other infections and hematologic diseases, other diagnostic tests were performed (Table 1) and the findings were normal. After the establishment of diagnosis the patient was transferred to the Clinic of Infectious Diseases where the causal therapy with 5-valent antimony was introduced, parenterally. As early as the first week of therapy, the patient was afebrile, subjective discomforts disappeared, she regained appetite and put on weight. Also, the decrease of the spleen was observed as well as improvement in hematological findings.

CONCLUSIONS

This paper predominantly deals with hematological findings which are characteristic for leishmaniasis on the basis of which the diagnosis of this disease has been quickly established (1,2). Hematological findings were the key of diagnosis being confirmed by serologic and other tests. The disease is very rare in this region, so that there is a difficulty in recognizing it. In our case, the diagnosis was made on the basis of sternal puncture survey, because protozoa were found in hy