Spleen nodules: a potential hallmark of Visceral Leishmaniasis in young children

BMC Infectious Diseases

Andrea Pession⁶  Rosalba Bergamaschi¹  Roberto Tigani²  Trentina Di Muccio³  Tamara Belotti⁶  Filomena Carfagnini⁵  Stefania Varani⁴  Fraia Melchionda⁶ 

[1] Pediatric Unit, St. Orsola-Malpighi Hospital University of Bologna, Bologna, Italy;Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), St. Orsola-Malpighi University Hospital, Bologna, Italy;Unit of Vector-Borne Diseases and International Health, MIPI Department, Istituto Superiore di Sanità, Rome, Italy;Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy;Pediatric Radiology Unit, St. Orsola-Malpighi Hospital University of Bologna, Bologna, Italy;Pediatric Hematology and Oncology Unit St. Orsola-Malpighi Hospital University of Bologna, Via Massarenti 11, Bldg 13, Bologna 40138, Italy

关键词: Abdominal ultrasonography;    Hemophagocytic lymphohistiocytosis;    Visceral leishmaniasis;   

Others  :  1118054
DOI  :  10.1186/s12879-014-0620-2

 received in 2014-05-14, accepted in 2014-11-07,  发布年份 2014

【 摘 要 】

Background

Visceral leishmaniasis (VL) is a severe disease caused by Leishmania infantum in the Mediterranean basin, and is associated with considerable morbidity and mortality. Infantile VL may begin suddenly, with high fever and vomiting, or insidiously, with irregular daily fever, anorexia, and marked splenomegaly. Delays in diagnosis of VL are common, highlighting the need for increased awareness of clinicians for VL in endemic European countries.

Case presentation

We report 4 cases of young children in northern Italy presenting with persistent fever of unknown origin and diagnosed with VL by serological and molecular methods. At the time of diagnosis, these patients showed an unusual echographic pattern characterized by multiple iso-hypoechoic nodules associated with splenomegaly.

Conclusion

We suggest that detection of spleen nodules represents a signature of VL in infants, thus helping to diagnose systemic Leishmania infantum infection in children.

【 授权许可】

   
2014 Melchionda et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Gramiccia M, Gradoni L: The current status of zoonotic leishmaniases and approaches to disease control. Int J Parasitol 2005, 35:1169-1180.
• [2]Ready PD: Leishmaniasis emergence in Europe.Euro Surveill 2010, 15:19505.
• [3]Maroli M, Rossi L, Baldelli R, Capelli G, Ferroglio E, Genchi C, Gramiccia M, Mortarino M, Pietrobelli M, Gradoni L: The northward spread of leishmaniasis in Italy: evidence from retrospective and ongoing studies on the canine reservoir and phlebotomine vectors. Trop Med Int Health 2008, 13:256-264.
• [4]Varani S, Cagarelli R, Melchionda F, Attard L, Salvadori C, Finarelli AC, Gentilomi GA, Tigani R, Rangoni R, Todeschini R, Scalone A, Di Muccio T, Gramiccia M, Gradoni L, Viale P, Landini MP: Ongoing outbreak of visceral leishmaniasis in Bologna Province, Italy, November 2012 to May 2013.Euro Surveill 2013, 18:20530.
• [5]Mueller YK, Kolaczinski JH, Koech T, Lokwang P, Riongoita M, Velilla E, Brooker SJ, Chappuis F: Clinical epidemiology, diagnosis and treatment of visceral leishmaniasis in the Pokot endemic area of Uganda and Kenya. Am J Trop Med Hyg 2014, 90:33-39.
• [6]Henter JI, Horne A, Aricó M, Egeler RM, Filipovich AH, Imashuku S, Ladisch S, McClain K, Webb D, Winiarski J, Janka G: HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007, 48:124-131.
• [7]Brandonisio O, Fumarola L, Maggi P, Cavaliere R, Spinelli R, Pastore G: Evaluation of a rapid immunochromatographic test for serodiagnosis of visceral leishmaniasis. Eur J Clin Microbiol Infect Dis 2002, 21:461-464.
• [8]Wortmann G, Sweeney C, Houng HS, Aronson N, Stiteler J, Jackson J, Ockenhouse C: Rapid diagnosis of leishmaniasis by fluorogenic polymerase chain reaction. Am J Trop Med Hyg 2001, 65:583-587.
• [9]Antinori S, Calattini S, Longhi E, Bestetti G, Piolini R, Magni C, Orlando G, Gramiccia M, Acquaviva V, Foschi A, Corvasce S, Colomba C, Titone L, Parravicini C, Cascio A, Corbellino M: Clinical use of polymerase chain reaction performed on peripheral blood and bone marrow samples for the diagnosis and monitoring of visceral leishmaniasis in HIV-infected and HIV-uninfected patients: a single-center, 8-year experience in Italy and review of the literature. Clin Infect Dis 2007, 44:1602-1610.
• [10]Mary C, Faraut F, Lascombe L, Dumon H: Quantification of Leishmania infantum DNA by a real-time PCR assay with high sensitivity. J Clin Microbiol 2004, 42:5249-5255.
• [11]Gagnaire MH, Galambrun C, Stéphan JL: Hemophagocytic syndrome: A misleading complication of visceral leishmaniasis in children–a series of 12 cases.Pediatrics 2000, 106:E58.
• [12]Chappuis F, Sundar S, Hailu A, Ghalib H, Rijal S, Peeling RW, Alvar J, Boelaert M: Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol 2007, 5:873-882.
• [13]Elmahallawy EK, Sampedro Martinez A, Rodriguez-Granger J, Hoyos-Mallecot Y, Agil A, Navarro Mari JM, Gutierrez Fernandez J: Diagnosis of leishmaniasis. J Infect Dev Ctries 2014, 8:961-972.
• [14]Patlas M, Hadas-Halpern I, Abrahamov A, Elstein D, Zimran A: Spectrum of abdominal sonographic findings in 103 pediatric patients with Gaucher disease. Eur Radiol 2002, 12:397-400.
• [15]Llenas-García J, Fernández-Ruiz M, Caurcel L, Enguita-Valls A, Vila-Santos J, Guerra-Vales JM: Splenic abscess: a review of 22 cases in a single institution. Eur J Intern Med 2009, 20:537-539.
• [16]Raeymaeckers S, Docx M, Demeyere N: MRI-findings of nodular lesions in an enlarged spleen, associated with visceral Leishmaniasis. Eur J Radiol 2012, 81:2550-2553.
• [17]Bükte Y, Nazaroglu H, Mete A, Yilmaz F: Visceral leishmaniasis with multiple nodular lesions of the liver and spleen: CT and sonographic findings. Abdom Imaging 2004, 29:82-84.
• [18]Singh G, Shabani-Rad MT, Vanderkooi OG, Vayalumkal JV, Kuhn SM, Guilcher GM, Steele M: Leishmania in HLH: A rare finding with significant treatment implications. J Pediatr Hematol Oncol 2013, 35:e127-e129.
• [19]Bhasin A, Tolan RW: Hemophagocytic lymphoistiocytosis- A diagnostic dilemma: Two cases and review. Clin Pediatr (Phila) 2013, 52:297-301.