Visceral leishmaniasis without fever in an 11-month-old infant: a rare clinical feature of Kala-azar

Leishmaniasis - Still a diagnostic challenge: An individual participant data systematic review

Leishmania, endemic in nearly half the world's countries, continues to pose significant diagnostic challenges. Our systematic review sought to analyse problems in diagnosis especially in low- to middle-income countries. The average time from symptom onset to diagnosis was 4.5 years. While microscopic detection often failed, polymerase chain reaction showed high sensitivity. Clinical presentations varied significantly, highlighting the complexity of diagnosing leishmaniasis, especially in patients with prolonged disease in non-endemic areas.

Filariasis presenting as pancytopenia in a child

A female child hailing from South Asia, India presented with pallor, multiple petechiae and ecchymosis. Based on the clinical picture and demography, the differentials considered were pancytopenia of nutritional origin, acute leukaemia, autoimmune and infective aetiologies. After ruling these out by respective tests, a literature review was done which revealed the possibility of filariasis especially in a patient with eosinophilia which was present in our case. A repeat peripheral blood smear study with a nocturnally drawn sample revealed multiple microfilariae and a diagnosis of filariasis was made. The patient was treated with triple drug therapy of diethylcarbamazine (6 mg/kg), ivermectin (6 µg/kg) and albendazole (400 mg) administered as a single dose. Subsequent haemograms showed improved cell counts. This along with a previous handful of case reports emphasises filariasis as one of the differentials of pancytopenia and should be kept in mind while evaluating for the same, especially in the endemic areas.

Visceral Leishmaniasis After Kidney Transplant: An Unusual Presentation and Mode of Diagnosis

Infection caused by Leishmania species has been increasingly reported in solid-organ transplant recipients since the first case report in 1979. Visceral leishmaniasis is endemic in central and eastern regions of India. Clinical features may simulate a variety of other infections, and a high index of suspicion is required for the diagnosis. Early diagnosis of this endemic infection is likely to result in improved outcome. We describe an unusual presentation of leishmaniasis in a kidney allograft recipient with organomegaly and pancytopenia sans fever detected by isolation of amastigotes in duodenal biopsy. To the best of our knowledge, this is the first case report of this kind in a kidney transplant recipient.

A case of visceral leishmaniasis found by left oblique hernia: A case report

Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania protozoa. Since sporadic cases of this disease are noted in non-endemic areas and are associated with a limited outbreak, the disease is easily overlooked. In addition, other illnesses exhibit similar symptoms. It is difficult for clinicians to establish an accurate diagnosis and develop effective treatments for this disease. The present study reported a case of a 25-year-old young man admitted to the hospital due to oblique hernia. The case was diagnosed as VL. The patient presented with persistent night sweats and fatigue as described in his admission history. However, the body temperature was normal. Routine examination revealed that the patient exhibited chronic hepatitis B infection, pancytopenia, hepatosplenomegaly, increased erythrocyte sedimentation rate, significant plasma cell infiltration in bone marrow aspirate and hypergammaglobulinemia. The retrospective analysis of the present case can improve the diagnostic accuracy and treatment rate of VL in non-epidemic areas.

Development of monoclonal antibodies against axenic amastigotes of Leishmania infantum strain in Iran: implication for diagnosis of Kala-azar

OBJECTIVES

Leishmaniasis is endemic in 88 countries. Amastigote forms of Leishmania are experts at exploiting host cell processes to establish infection. Monoclonal antibodies are key reagents used in the diagnosis of infectious and non-infectious diseases. The aim of this study was to produce monoclonal antibodies against axenic amastigotes of the Leishmaniainfantum strain in Iran.

MATERIALS AND METHODS

First, standard strains were cultured and axenic amastigote antigens of L. infantum were obtained. Since then, BALB/c smice were immunized and antibody titers were determined. For hybridoma cell formation, lymphocytes isolated from spleen of immunized mice and myeloma cells were fused at a ratio of 10 to 1 in the presence of polyethylene glycol, followed by limiting dilution for the isolation of monoclones. Subsequently, antibody isotypes were determined by using the isotyping kit. The best clone was injected intraperitoneally to pristane-primed mice for large scale production of monoclonal antibodies. The specificity of antibody was determined with Western blotting.

RESULTS

Approximately 25 positive monoclones were obtained, of which four hybrids producing anti-amastigotes L. infantum monoclonal antibodies with high optical density (OD), selected and designated as 8D2 FVI6, 8D2 FVI3, 6G2 FV4 and 6G2 FV3. Results from isotype determination showed the IgG2b sub-class in 6G2FV2 and 8D2FVI6 monoclones.

CONCLUSION

This study produced monoclonal antibody against amastigotes of Iranian strain of L. infantum for the first time. These antibodies have reactivity against Iranian strain of L. infantum and can be used in the diagnosis of Kala-azar.

T cell suppression in the bone marrow of visceral leishmaniasis patients: impact of parasite load

Visceral leishmaniasis (VL) is a disseminated and lethal disease of reticulo-endothelial system caused by protozoan parasites Leishmania donovani and L. infantum, which are known to induce host T cell suppression. To understand the impact of parasite load on T cell function, the present was focused on parasite load with T cell function in bone marrow of 26 VL patients. We observed significant enrichment of forkhead box protein 3 (FoxP3)⁺ (P = 0·0003) and interleukin (IL)-10⁺ FoxP3⁺ regulatory T cells (T_reg ) (P = 0·004) in the bone marrow (BM) of patients with high parasite load (HPL) compared with low parasite load (LPL). Concordantly, T effector cells producing interferon (IFN)-γ (P = 0·005) and IL-17A (P = 0·002) were reduced in the BM of HPL. Blocking of T_reg -cell derived suppressive cytokines [(IL-10 and transforming growth factor (TGF)-β] rescued the effector T cells and their functions. However, it was observed that TGF-β levels were dominant, favouring T_reg cell differentiation. Furthermore, the low ratio of IL-6/TGF-β favours the suppressive milieu in HPL patients. Here we show the change in levels of various cytokines with the parasitic load during active VL, which could be helpful in devising newer immunotherapeutic strategies against this disease.

Leishmaniasis as a Neglected Cause of Isolated Lymphadenopathy: A Case Report

Leishmaniasis is an endemic parasitic disease in Iran. This paper reports the case of a 5-yr-old boy who presented with multiple isolated cervical lymphadenopathy for several months with no history of fever and no signs or symptoms. In an excisional lymph node biopsy, Leishmania parasites were histologically detected. Thus, leishmaniasis should be included in the differential diagnosis of isolated lymphadenitis in immunocompetent patients, even if the K39 and IFA for kala-azar are reported as negative.