Martín-Sánchez Joaquina, Navarro-Mari José M, Pasquau-Liaño Juan, Salomón Oscar D, Morillas-Márquez Francisco
Departamento de Parasitología, Facultad de Farmacia, Campus Universitario de Cartuja 18,071, Universidad de Granada, Spain.
BMC Infect Dis. 2004 Jun 29;4:20. doi: 10.1186/1471-2334-4-20.
The question "Where have you been?" is a common one asked by doctors in Northern Europe and America when faced with clinical symptoms not typical of their country. This question must also arise in the clinics of developing countries in which non-autochthonous cases such as the one described here can appear. Important outbreaks of Leishmania infantum have been recorded in the last decade in several Latin American countries but its presence has not yet been recorded in Argentina. We report the first case of visceral leishmaniasis owing to L. infantum in this country.
A 71-year-old Spanish woman who has been living in Mendoza, Argentina, during the last 40 years presented with a history of high fever and shivering, anemia, leukopenia and splenomegaly over two years. Argentinian doctors did not suspect visceral leishmaniasis even when the histological analysis revealed the presence of "intracytoplasmatic spheroid particles compatible with fungal or parasitic infection". After a serious deterioration in her health, she was taken to Spain where she was evaluated and visceral leishmaniasis was established. Specific identification of the parasite was done by PCR-ELISA, isoenzyme electrophoresis and RAPD-PCR.
We would like to point out that: i) cases such as the one described here, which appear in non-endemic areas, can pass unnoticed by the clinical physician. ii) in countries in which these introduced cases reside, in-depth parasitological studies are required into vectors and possible reservoirs to rule out the rare case of local infection and, once infection has taken place, to ensure that this does not spread by anthroponotic transmission or a competent reservoir.
“你去过哪里？”这个问题是北欧和美国的医生在面对非本国典型临床症状时经常问到的。在发展中国家的诊所里，当出现像本文所述的非本地病例时，这个问题也必然会出现。在过去十年中，几个拉丁美洲国家都记录到了婴儿利什曼原虫的重要疫情，但阿根廷尚未记录到其存在。我们报告该国首例由婴儿利什曼原虫引起的内脏利什曼病病例。
一名71岁的西班牙女性，在过去40年一直生活在阿根廷门多萨，出现了持续两年的高热、寒战、贫血、白细胞减少和脾肿大病史。即使组织学分析显示存在“与真菌或寄生虫感染相符的胞质内球状颗粒”，阿根廷医生也未怀疑内脏利什曼病。在她的健康状况严重恶化后，她被送往西班牙，在那里接受评估并确诊为内脏利什曼病。通过PCR-ELISA、同工酶电泳和RAPD-PCR对寄生虫进行了特异性鉴定。
我们想指出：i）像本文所述的这种出现在非流行地区的病例，临床医生可能会忽视。ii）在有这些输入性病例的国家，需要对媒介和可能的储存宿主进行深入的寄生虫学研究，以排除罕见的本地感染病例，并在感染发生后确保其不会通过人传人或有能力的储存宿主传播。
