Department of Internal Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America.
Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, United States of America.
PLoS Negl Trop Dis. 2018 Oct 4;12(10):e0006727. doi: 10.1371/journal.pntd.0006727. eCollection 2018 Oct.
A young, healthy traveler returning to the United States presented with fever, night sweats, splenomegaly, and pancytopenia. Bone marrow biopsy revealed leishmaniasis (Leishmania infantum), likely acquired in southern France. Although many cases of endemic visceral leishmaniasis (VL) have been reported in Europe, this is a rare case of imported VL in a healthy traveler returning from Europe to the US. Despite successful initial treatment with liposomal amphotericin B (LamB), relapse occurred. Treatments for VL in immunocompetent individuals are highly effective, but relapse can occur. There is more extensive experience in endemic areas with treating relapse that may be lacking in North America. This case alerts physicians in the US that immunocompetent adults can acquire VL during brief visits to endemic areas in Europe. It is important that travelers be counseled on preventive measures. Patients should be monitored after treatment for relapse.
一位年轻健康的旅行者返回美国时出现发热、盗汗、脾肿大和全血细胞减少。骨髓活检显示利什曼病（婴儿利什曼原虫），可能在法国南部获得。尽管在欧洲已经报告了许多地方性内脏利什曼病（VL）病例，但这是一例来自欧洲返回美国的健康旅行者中罕见的输入性 VL 病例。尽管最初用脂质体两性霉素 B（LamB）成功治疗，但出现了复发。免疫功能正常者的 VL 治疗非常有效，但可能会复发。在治疗复发方面，在地方性流行地区有更广泛的经验，而在北美可能缺乏这种经验。该病例提醒美国医生，免疫功能正常的成年人在前往欧洲地方性流行地区短暂旅行时也可能感染 VL。重要的是要告知旅行者预防措施。治疗后应监测患者是否复发。
