Recurrent kala-azar: report of two cured cases after total splenectomy

Abstract

This is an open-access article distributed under the terms of the Creative Commons Attribution License.

Is splenectomy an option for multiple relapses in a child with visceral leishmaniasis? A case report

“…The effect of splenectomy in patients with VL has not been well defined. In two immunocompetent adult cases with multiple leishmaniasis relapses and exhausted drug therapy, splenectomy was performed as surgical treatment with a curative purpose and showed a good clinical response to hypersplenism and other clinical repercussions 8 . Other cases in which splenectomy had been successful in minimizing the effects of hypersplenism and curing refractory cases of VL have been described in India 5 , 9 .…”

“…However, two cases were reported in which parasites remained present in the lymph nodes after clinical cure 10 , demonstrating that the reticuloendothelial system, especially the spleen, can be a reservoir of infected cells, thus justifying surgical intervention in specific cases 8 . The success of splenectomy was observed in a report by Dutra et al and was associated with the removal of large amounts of parasites from the reticuloendothelial system and the correction of hypersplenism, a fact that was not observed in the patient in this case, since there were clinical recurrences and changes in the laboratory parameters, even after splenectomy.…”

“…The effect of splenectomy in patients with VL has not been well defined. In two immunocompetent adult cases with multiple leishmaniasis relapses and exhausted drug therapy, splenectomy was performed as surgical treatment with a curative purpose and showed a good clinical response to hypersplenism and other clinical repercussions 8 . Other cases in which splenectomy had been successful in minimizing the effects of hypersplenism and curing refractory cases of VL have been described in India 5,9 . However, two cases were reported in which parasites remained present in the lymph nodes after clinical cure 10 , demonstrating that the reticuloendothelial system, especially the spleen, can be a reservoir of infected cells, thus justifying surgical intervention in specific cases 8 .…”

“…In two immunocompetent adult cases with multiple leishmaniasis relapses and exhausted drug therapy, splenectomy was performed as surgical treatment with a curative purpose and showed a good clinical response to hypersplenism and other clinical repercussions 8 . Other cases in which splenectomy had been successful in minimizing the effects of hypersplenism and curing refractory cases of VL have been described in India 5,9 . However, two cases were reported in which parasites remained present in the lymph nodes after clinical cure 10 , demonstrating that the reticuloendothelial system, especially the spleen, can be a reservoir of infected cells, thus justifying surgical intervention in specific cases 8 . The success of splenectomy was observed in a report by Dutra et al and was associated with the removal of large amounts of parasites from the reticuloendothelial system and the correction of hypersplenism, a fact that was not observed in the patient in this case, since there were clinical recurrences and changes in the laboratory parameters, even after splenectomy.…”

Trauma esplénico: diagnostico, clasificación y tratamiento. Una revisión de la literatura actual

“…En cuanto al tratamiento quirúrgico existen dos opciones; la esplenectomía abierta y la esplenectomía total laparoscópica. La técnica de esplenectomía abierta consiste en realizar una incisión vertical en la línea media que se extiende desde la apófisis xifoides hasta la sínfisis púbica (13), que en comparación con las tres (o cuatro) pequeñas incisiones que se realizan en una esplenectomía total laparoscópica se entiende las ventajas de dicho tratamiento (14). En cuanto a técnicas de laparoscopía se describe también la esplenectomía parcial en la cual se extirpa una parte del bazo y se prefiere dejar el polo superior del órgano debido a que tiene mayor cantidad de elementos de fijación lo que evita la torsión en el posoperatorio (7).…”