Visceral Leishmaniasis Associated with Hemophagocytic Lymphohistiocytosis

Bolia, Rishi; Singh, Avinish; Maji, Manideepa; Misra, Medha; Sharawat, Indar Kumar; Panda, Prateek Kumar

doi:10.1007/s12098-020-03361-5

Cited by 4 publications

(3 citation statements)

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“…Leishmania infection is a well-known cause of infection associated HLH [4,[8][9][10][11]. It was reported that about 25.77% of patients with adult hemophagocytic syndrome were induced by Leishmania infection [12].…”

Section: Introductionmentioning

confidence: 99%

Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection

Shi

Huang

et al. 2021

PLoS Negl Trop Dis

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Background Visceral leishmaniasis (VL) could progress to secondary hemophagocytic lymphohistiocytosis (HLH), which is a rare but life-threatening condition with poor prognosis. So far, the clinical and laboratory characteristics of VL associated HLH have not been well elucidated. Method and findings In this study, we retrospectively analyzed the clinical and laboratory profiles between 17 patients with VL associated HLH and 27 patients with VL alone admitted at the Beijing Friendship Hospital, Capital Medical University from May 2016 to March 2021. In addition to the identification of Leishmania infection, hemophagocytosis was identified in bone marrow in the most cases of VL associated HLH (15/17). The patients with VL associated HLH had higher chances of bleeding, hepatomegaly, thrombocytopenia, hypertriglyceridemia, hyperferritinemia, hypofibrinogenemia, elevated secretion of soluble IL-2 receptor or lower NK cell activity compared to patients with VL only. Furthermore, patients with VL associated HLH had higher inflammation status associated with higher levels of Th1 (TNF-α, IFN-γ, IL-1beta, IL-6, IL-8, IL-12p70), Th2 (IL-4) and Th17 cytokines (IL-17, IL-23) in the peripheral blood, and higher parasite load (qPCR and parasite culture). All 27 VL cases were totally recovered after being treated with Sodium Stibogluconate, five of the 17 patients with VL associated HLH died even after timely treatment with anti-parasite and immunosuppressive chemotherapy. Conclusion Without appropriate treatment, visceral leishmaniosis could develop to secondary HLH. The parasite culturing and qPCR detection of bone marrow samples facilitates the diagnosis of VL associated HLH in addition to other findings of HLH. Prompt treatment with anti-Leishmania and immunosuppressive chemotherapy is critical to reduce the mortality of VL associated HLH.

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Section: Introductionmentioning

confidence: 99%

Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection

Shi

Huang

et al. 2021

PLoS Negl Trop Dis

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“…Parasite strains from Sudan examined by PCR single strand conformation polymorphism did not show correlation with clinical manifestations ( Bermudi et al., 2020 ). VL and PKDL strains clustered in the same branches of the tree examined by multi-locus microsatellite typing (MLMT) or multi-locus sequence typing (MLST) ( Alkhaldy et al., 2020 ; Bolia et al., 2020 ).…”

Section: Resultsmentioning

confidence: 99%

Precision Medicine in Control of Visceral Leishmaniasis Caused by L. donovani

Zijlstra¹

2021

Front. Cell. Infect. Microbiol.

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Precision medicine and precision global health in visceral leishmaniasis (VL) have not yet been described and could take into account how all known determinants improve diagnostics and treatment for the individual patient. Precision public health would lead to the right intervention in each VL endemic population for control, based on relevant population-based data, vector exposures, reservoirs, socio-economic factors and other determinants. In anthroponotic VL caused by L. donovani, precision may currently be targeted to the regional level in nosogeographic entities that are defined by the interplay of the circulating parasite, the reservoir and the sand fly vector. From this 5 major priorities arise: diagnosis, treatment, PKDL, asymptomatic infection and transmission. These 5 priorities share the immune responses of infection with L. donovani as an important final common pathway, for which innovative new genomic and non-genomic tools in various disciplines have become available that provide new insights in clinical management and in control. From this, further precision may be defined for groups (e.g. children, women, pregnancy, HIV-VL co-infection), and eventually targeted to the individual level.

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“…A LV é provocada pelo protozoário Leishmania donovani e representa uma causa incomum de LHH, sendo associada a cerca de 2,1% dos casos (BOLIA et al, 2021) Em relação aos testes rápidos, eles são considerados positivos quando as linhas de controle e teste aparecem coradas na fita ou plataforma. Caso o paciente com clínica sugestiva de LV apresente teste rápido reagente, não há necessidade de realizar outro teste para a confirmação, podendo ser instituída a terapia medicamentosa específica para a doença (BRASIL, 2022a).…”

Section: Epidemiologiaunclassified

Síndrome hemofagocítica pós-leishmaniose visceral: revisão de literatura e relato de caso

Souza¹,

Pizzol²,

Leite³

et al. 2022

Braz. J. Hea. Rev.

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Introdução: A Síndrome Hemofagocítica (SH), também chamada de Linfo-histiocitose Hemofagocítica (LHH), é uma doença rara, de acometimento multissistêmico resultante da ativação excessiva de linfócitos T citotóxicos, células natural killer e macrófagos, levando à secreção de citocinas pró-inflamatórias. Quando associada à Leishmaniose Visceral (LV) se torna um quadro de difícil diagnóstico, visto que os sintomas são semelhantes. Objetivos: Realizar relato do caso e revisão bibliográfica sobre HHpós-LV em uma paciente pediátrica. Relato do caso: Paciente 1 ano e 8 meses, apresentava história de febre iniciada há cerca de 15 dias, evoluindo com prostração, hiporexia, distensão abdominal, hepatoesplenomegalia e palidez. À admissão hospitalar, apresentou resultado de teste rápido positivo para LV, e recebeu tratamento com desoxicolato de anfotericina B, 1mg/kg/dia, em uma dose diária. Posteriormente, o diagnóstico foi confirmado pelo exame de PCR. A paciente recebeu alta hospitalar após 22 dias de internação. Discussão: O uso de anfotericina B lipossomal leva à remissão permanente do quadro, entretanto nem sempre a terapia antiparasitária será resolutiva para a LHH/LV e, devido à alta letalidade da doença, há a necessidade de iniciar medicamentos imunossupressores ou antiinflamatórios em caráter imediato para evitar um desfecho fatal. No caso clínico discutido, optou-se por iniciar anfotericina B para tratamento da LV, com desfecho positivo para a paciente. A paciente não precisou iniciar o esquema terapêutico imunossupressor, uma vez que a monoterapia antiparasitária foi resolutiva. Evoluiu favoravelmente, recebendo alta para domicílio no 22º dia de internação. Conclusão: A LHH deve ser considerada suspeita em casos de LV de evolução lenta, com febre prolongada, esplenomegalia e citopenias refratárias, especialmente em crianças de área endêmica, considerando que é uma condição potencialmente fatal se não tratada. Vale enfatizar a semelhança clínica e do hemograma em ambas as doenças, o que torna o diagnóstico complexo e, consequentemente, atrasa o tratamento.

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Visceral Leishmaniasis Associated with Hemophagocytic Lymphohistiocytosis

Cited by 4 publications

References 4 publications

Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection

Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection

Precision Medicine in Control of Visceral Leishmaniasis Caused by L. donovani

Síndrome hemofagocítica pós-leishmaniose visceral: revisão de literatura e relato de caso

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