Angkor Hospital for Children, Siem Reap, Cambodia.
Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.
Am J Trop Med Hyg. 2022 Jun 13;107(2):336-338. doi: 10.4269/ajtmh.22-0085. Print 2022 Aug 17.
Leishmaniasis is considered a neglected tropical disease that is commonly found in Asia, Africa, South America, and Mediterranean countries. Visceral leishmaniasis (VL) is the most severe form of the disease and is almost universally fatal if left untreated. The symptoms of VL overlap with many infectious diseases, malignancies, and other blood disorders. The most common findings include fever, cytopenias, and splenomegaly. Given the nonspecific symptoms, the diagnosis requires detailed laboratory investigations, including bone marrow examination, that can be challenging in low- and middle-income countries. Diagnostic limitations likely lead to the underdiagnosis or delay in diagnosis of VL. We describe, to our knowledge, the first case report of VL in Cambodia in a child presenting with fever, anemia, and thrombocytopenia. The diagnosis required a liver biopsy and multiple bone marrow biopsies to visualize intracellular Leishmania spp. Our case illustrates the diagnostic challenges and the importance of timely diagnosis. This case also highlights the need for heightened awareness of the diagnostic findings of VL and improved reporting of tropical diseases.
利什曼病被认为是一种被忽视的热带病，常见于亚洲、非洲、南美洲和地中海国家。内脏利什曼病（VL）是该病最严重的形式，如果未经治疗，几乎普遍致命。VL 的症状与许多传染病、恶性肿瘤和其他血液疾病重叠。最常见的发现包括发热、细胞减少症和脾肿大。鉴于症状无特异性，诊断需要详细的实验室检查，包括骨髓检查，但在低收入和中等收入国家可能具有挑战性。诊断上的局限性可能导致 VL 的漏诊或诊断延迟。据我们所知，我们描述了柬埔寨首例儿童发热、贫血和血小板减少症表现的 VL 病例。该诊断需要进行肝活检和多次骨髓活检，以观察细胞内利什曼原虫属。我们的病例说明了诊断上的挑战以及及时诊断的重要性。该病例还强调了提高对 VL 诊断结果的认识和加强热带病报告的必要性。
