Kumar Perikala Vijayananda, Vasei Mohammad, Sadeghipour Alireza, Sadeghi Esmaeel, Soleimanpour Hossein, Mousavi Abdullah, Tabatabaei Ameer Hussein, Rizvi Mehid Muntazer
Department of Pathology and Cancer research institute, Shiraz Medical School, Shiraz, Iran.
J Pediatr Hematol Oncol. 2007 Feb;29(2):77-80. doi: 10.1097/MPH.0b013e31803076a8.
Visceral leishmaniasis (VL) or Kala-azar is a common parasitic infection among children in Iran. The records of 249 children with VL were evaluated retrospectively. The clinical, hematologic, and bone marrow biopsy findings were studied. In particular, we assessed whether there was an association between bone marrow biopsy findings and prognosis. Five major groups were identified: (1) hypercellular marrow with many Leishman Donovan (LD) bodies, (2) multiple noncaseating granulomas with a few LD bodies, (3) diffuse fibrosis with rare LD bodies, (4) benign lymphoid nodules with many LD bodies, and (5) marrow necrosis with many LD bodies. The patients with hypercellular marrow and benign lymphoid nodules were alive and responded well to glucantime therapy. The patients with marrow fibrosis and marrow necrosis died and were resistant to any type of therapy. Patients with granulomas did not respond to glucantime therapy but responded to amphotericin B. However, less than half of the patients died owing to malnutrition and misdiagnosis. We correlated the bone marrow biopsy findings with the treatment outcomes and prognosis. The outcome was excellent in cases of hypercellular marrow, very poor in cases of fibrosis and necrosis, and intermediate in cases of granulomas. As a result, we believe that bone marrow biopsy findings can be helpful for assessing the prognosis of VL patients.
内脏利什曼病（VL）或黑热病是伊朗儿童中常见的寄生虫感染。对249例VL患儿的记录进行了回顾性评估。研究了临床、血液学和骨髓活检结果。特别是，我们评估了骨髓活检结果与预后之间是否存在关联。确定了五个主要组：（1）骨髓细胞增多伴许多利杜体（LD），（2）多个非干酪样肉芽肿伴少数LD体，（3）弥漫性纤维化伴罕见LD体，（4）良性淋巴结节伴许多LD体，（5）骨髓坏死伴许多LD体。骨髓细胞增多和良性淋巴结节的患者存活，对葡糖胺锑钠治疗反应良好。骨髓纤维化和骨髓坏死的患者死亡，对任何类型的治疗均耐药。肉芽肿患者对葡糖胺锑钠治疗无反应，但对两性霉素B有反应。然而，不到一半的患者因营养不良和误诊死亡。我们将骨髓活检结果与治疗结果和预后相关联。骨髓细胞增多的病例结果极佳，纤维化和坏死的病例结果极差，肉芽肿的病例结果中等。因此，我们认为骨髓活检结果有助于评估VL患者的预后。
