Marković Ivan, Gudelj-Gracanin Ana, Culo Melanie-Ivana, Stoos-Veić Tajana, Vicković Ninoslava, Desnica Bosko, Morović-Vergles Jadranka
Lijec Vjesn. 2014 Jan-Feb;136(1-2):22-4.
Visceral leishmaniasis or kala-azar is a systemic infectious vector-borne disease caused by protozoa Leishmania donovani and Leishmania infantum that are transmitted to mammalian hosts by sand flies. It occurrs sporadically in endemic areas, including Mediterranean basin. Southern coastal territories of Croatia have been recognized as the foci of the disease. Dogs are the main reservoir of human infection. Clinical features include prolonged fever, malaise, hepatosplenomegaly, pancytopenia and inversion of albumin-globulin ratio. If left untreated, the disease causes death in majority of cases. We report a 47-year-old Croatian patient who was admitted to hospital with 2-month history of fever of unknown origin. Based on bone marrow aspirate findings and positive serological tests, the diagnosis of visceral leishmaniasis was established. We also considered secondary hemophagocytic lymphohystiocytosis in the differential diagnosis. After a 4-week treatment with sodium-stibogluconate clinical remission was achieved as well as complete recovery of hematopoesis. The aim of our case-report is to stress the importance of considering visceral leishmaniasis in patients with longstanding fever in endemic areas.
内脏利什曼病或黑热病是一种由杜氏利什曼原虫和婴儿利什曼原虫引起的系统性感染性媒介传播疾病，这些原虫通过白蛉传播给哺乳动物宿主。该病在地中海盆地等流行地区呈散发性发生。克罗地亚南部沿海地区已被确认为该病的疫源地。狗是人类感染的主要储存宿主。临床特征包括长期发热、不适、肝脾肿大、全血细胞减少和白蛋白-球蛋白比例倒置。如果不进行治疗，该病在大多数情况下会导致死亡。我们报告一名47岁的克罗地亚患者，因不明原因发热2个月入院。根据骨髓穿刺结果和血清学检查阳性，确诊为内脏利什曼病。我们在鉴别诊断中还考虑了继发性噬血细胞性淋巴组织细胞增生症。在用葡萄糖酸锑钠治疗4周后，临床症状缓解，造血功能完全恢复。我们病例报告的目的是强调在流行地区长期发热患者中考虑内脏利什曼病的重要性。
