Rodrigues Monteiro Miguel, Serra João Tiago, Gomes Filipa, Tinoco Joaquim
Serviço de Medicina 2. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.
Serviço de Medicina Interna. Hospital CUF Sintra. Sintra. Portugal.
Acta Med Port. 2023 Dec 4;36(12):835-840. doi: 10.20344/amp.19010. Epub 2023 Jun 23.
Leishmaniasis is a parasitic disease transmitted by the bite of female sandflies that occurs in tropical and subtropical climate regions. Visceral leishmaniasis is the most serious manifestation of the disease, leading to a 95% mortality rate after two years of infection if untreated. Visceral leishmaniasis is frequently associated with immunocompromised states, with the human immunodeficiency virus being the most prevalent. Most cases of visceral leishmaniasis are caused by the species Leishmania donovani and Leishmania infantum, the latter being the endemic species in the Mediterranean basin. In Portugal, the number of reported cases of visceral leishmaniasis has decreased in the last few years, with 15 cases reported between 2017 and 2021. The authors present a case of visceral leishmaniasis in an immunocompetent patient who manifested the classic pentad: fever, weight loss, hepatosplenomegaly, pancytopenia and hypergammaglobulinemia. The diagnosis was made by the observation of amastigotes of the Leishmania infantum species in the bone marrow aspirate examination, and the patient was successfully treated with liposomal amphotericin B.
利什曼病是一种由雌性白蛉叮咬传播的寄生虫病，发生在热带和亚热带气候地区。内脏利什曼病是该疾病最严重的表现形式，如果不治疗，感染两年后的死亡率可达95%。内脏利什曼病常与免疫功能低下状态相关，其中人类免疫缺陷病毒最为常见。大多数内脏利什曼病病例由杜氏利什曼原虫和婴儿利什曼原虫引起，后者是地中海盆地的地方病物种。在葡萄牙，过去几年内脏利什曼病的报告病例数有所下降，2017年至2021年间报告了15例。作者介绍了一例免疫功能正常的患者发生内脏利什曼病的病例，该患者表现出典型的五联征：发热、体重减轻、肝脾肿大、全血细胞减少和高球蛋白血症。通过在骨髓穿刺检查中观察到婴儿利什曼原虫的无鞭毛体做出诊断，该患者用脂质体两性霉素B成功治愈。
