Vutova Kamenna, Yancheva-Petrova Nina, Tchipeva Rossitsa, Velev Valeri
Medical College, Medical University of Sofia, 3 "Y. Filaretova St.", 1606 Sofia, Bulgaria.
Medical Center of University Hospital "St. I. Rilski" EAD, 15 "Acad. I. Geshov Blvd.", 1606 Sofia, Bulgaria.
Pathogens. 2024 Feb 26;13(3):205. doi: 10.3390/pathogens13030205.
Visceral leishmaniasis (VL) is a severe endemic disease with a fatal outcome if left untreated. The symptoms of patients are diverse and atypical. Against the background of anemia and pancytopenia, the condition of the patients gradually worsens with marked cachexia. Through sharing our experience, we aim to draw attention to this deadly disease. Clinical and laboratory data for 58 patients with VL treated over a forty-five-year period are presented. The diagnosis was established within a duration of 1 to 28 months of illness. Continuous fever (38-42 °C), splenomegaly, hepatomegaly, severe anemia (decreased hemoglobin to lowest values of 31 g/L), leucopenia (lowest values of leucocytes et 0.5 g/L), and thrombocytopenia (reduced thrombocyte count to 29 g/L) were observed. The diagnosis was made on the basis of microscopic evidence of amastigote forms in bone marrow smears and serological tests. The patients were treated with Glucantime for 17 to 21 days. Relapses were observed in seven patients (12.1%) and fatal outcome was observed in two patients (3.5%) during treatment, who developed acute respiratory and cardiovascular failure. In Bulgaria, Visceral leishmaniasis is primarily endemic in the southern regions and should be suspected not only in patients who have returned from tropical and subtropical countries, but also in those who have not traveled abroad. The challenges associated with VL stem from delayed diagnosis of patients, as this disease remains unrecognized by physicians.
内脏利什曼病（VL）是一种严重的地方病，若不治疗会导致致命后果。患者症状多样且不典型。在贫血和全血细胞减少的背景下，患者病情逐渐恶化，出现明显恶病质。通过分享我们的经验，我们旨在引起人们对这种致命疾病的关注。本文介绍了45年间接受治疗的58例内脏利什曼病患者的临床和实验室数据。诊断在发病1至28个月内确立。观察到持续发热（38 - 42°C）、脾肿大、肝肿大、严重贫血（血红蛋白降至最低值31g/L）、白细胞减少（白细胞最低值0.5g/L）和血小板减少（血小板计数降至29g/L）。诊断基于骨髓涂片和血清学检测中无鞭毛体形式的显微镜证据。患者接受葡糖胺锑钠治疗17至21天。治疗期间，7例患者（12.1%）复发，2例患者（3.5%）出现急性呼吸和心血管衰竭导致死亡。在保加利亚，内脏利什曼病主要流行于南部地区，不仅应怀疑来自热带和亚热带国家的归国患者，还应怀疑未出过国的患者。与内脏利什曼病相关的挑战源于患者诊断延迟，因为这种疾病仍未被医生所认识。
