1/3. Visceral leishmaniasis caused by leishmania infantum in a Spanish patient in argentina: What is the origin of the infection? Case report.BACKGROUND: The question "Where have you been?" is a common one asked by doctors in Northern europe and America when faced with clinical symptoms not typical of their country. This question must also arise in the clinics of developing countries in which non-autochthonous cases such as the one described here can appear. Important outbreaks of leishmania infantum have been recorded in the last decade in several Latin American countries but its presence has not yet been recorded in argentina. We report the first case of visceral leishmaniasis owing to L. infantum in this country. CASE PRESENTATION: A 71-year-old Spanish woman who has been living in Mendoza, argentina, during the last 40 years presented with a history of high fever and shivering, anemia, leukopenia and splenomegaly over two years. Argentinian doctors did not suspect visceral leishmaniasis even when the histological analysis revealed the presence of "intracytoplasmatic spheroid particles compatible with fungal or parasitic infection". After a serious deterioration in her health, she was taken to spain where she was evaluated and visceral leishmaniasis was established. Specific identification of the parasite was done by PCR-ELISA, isoenzyme electrophoresis and RAPD-PCR. CONCLUSION: We would like to point out that: i) cases such as the one described here, which appear in non-endemic areas, can pass unnoticed by the clinical physician. ii) in countries in which these introduced cases reside, in-depth parasitological studies are required into vectors and possible reservoirs to rule out the rare case of local infection and, once infection has taken place, to ensure that this does not spread by anthroponotic transmission or a competent reservoir.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Serodiagnosis of visceral leishmaniasis in an American peace corps volunteer.A case of visceral leishmaniasis in a young American peace corps volunteer is reported. Both clinical and epidemiologic evidence strongly supported the diagnosis; however, hepatic and splenic aspirates for the causative organism were negative. The diagnosis was eventually confirmed through serology, employing indirect immunofluorescence and complement fixation testing of serum. The patient clinically responded dramatically to sodium stibogluconate, the drug of choice for the treatment of visceral leishmaniasis. This case is significant because it alerts the physician to an unusual cause of fever of unknown origin in residents of the Western nations and demonstrates the potential usefulness of serology in diagnosing visceral leishmaniasis when the infecting organism cannot be isolated.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. Visceral leishmaniasis (kala-azar) after a visit to the mediterranean region.The case of a 17-year-old patient is presented who became ill 10 months after a holiday visit to malta. Symptoms included fever peaking daily at 40 degrees C, pancytopenia, and splenomegaly. There was no evidence of bacterial or virological involvement, and probatory treatment with antibiotics followed by corticosteroids was without success. Examination of bone marrow led to the diagnosis of visceral leishmaniasis (kala-azar). A therapy with pentavalent antimony brought rapid improvement in clinical symptoms and led to complete recovery. A short review is presented of the epidemiology, diagnosis, and therapy of visceral leishmaniasis. The aim of this presentation is to remind the attendant physician of the clinical symptoms involved with the possible case of visceral leishmaniasis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |