Jancar Nina, Sousa Gonçalves Filipa, Duro José, Pinto Inês, Oliveira Tiago, Aguiar Patrício
Internal Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT.
Pathology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT.
Cureus. 2023 Feb 11;15(2):e34864. doi: 10.7759/cureus.34864. eCollection 2023 Feb.
Leishmaniasis is a zoonosis caused by unicellular protozoans . The transmission can be zoonotic or anthroponotic, depending on the species, and the main vector is the phlebotomine sandfly. The disease is endemic in the tropics of Asia and Africa but is considered rare in Portugal, especially in immunocompetent hosts. Its main clinical syndromes constitute cutaneous leishmaniasis, mucocutaneous disease, and visceral leishmaniasis. The latter is also known as and is caused by the infection of the phagocytes of the reticuloendothelial system, causing the typical symptoms: fever, hepatosplenomegaly, and pancytopenia. The clinical manifestations are non-specific, frequently causing a delay in the diagnosis, especially in nonendemic areas and immunocompetent hosts. Early diagnosis and treatment are essential, given the high mortality rate in untreated patients. The diagnosis is based on the direct visualization of the protozoan and molecular methods, such as polymerase chain reaction tests. Amphotericin B is considered the first-line treatment. We present a case of visceral leishmaniasis in an immunocompetent patient with fever, hepatosplenomegaly, and pancytopenia.
利什曼病是一种由单细胞原生动物引起的人畜共患病。根据种类不同，其传播方式可以是动物传染给人的，也可以是人与人之间传播的，主要传播媒介是白蛉。该病在亚洲和非洲的热带地区为地方病，但在葡萄牙被认为较为罕见，尤其是在免疫功能正常的宿主中。其主要临床综合征包括皮肤利什曼病、黏膜皮肤型疾病和内脏利什曼病。后者也被称为黑热病，是由网状内皮系统的吞噬细胞感染引起的，会导致典型症状：发热、肝脾肿大和全血细胞减少。临床表现不具有特异性，常常导致诊断延误，尤其是在非流行地区和免疫功能正常的宿主中。鉴于未经治疗的患者死亡率很高，早期诊断和治疗至关重要。诊断基于原生动物的直接可视化以及分子方法，如聚合酶链反应检测。两性霉素B被认为是一线治疗药物。我们报告一例免疫功能正常的患者出现发热、肝脾肿大和全血细胞减少，诊断为内脏利什曼病的病例。
