Visceral leishmaniasis and hemophagocytic syndrome

Détails

ID Serval
serval:BIB_A1E7074EE2ED
Type
Actes de conférence (partie): contribution originale à la littérature scientifique, publiée à l'occasion de conférences scientifiques, dans un ouvrage de compte-rendu (proceedings), ou dans l'édition spéciale d'un journal reconnu (conference proceedings).
Sous-type
Abstract (résumé de présentation): article court qui reprend les éléments essentiels présentés à l'occasion d'une conférence scientifique dans un poster ou lors d'une intervention orale.
Collection
Publications
Titre
Visceral leishmaniasis and hemophagocytic syndrome
Titre de la conférence
Joint annual meeting of the Swiss Society for Pediatrics, Swiss Society of Pediatric Pneumology
Auteur(s)
Paccaud Y., Kuchler H., Beck Popovic M., Vaudaux B., Llor J., Tabin R., Cheseaux J.J.
Adresse
Crans Montana, Switzerland, June 17-18, 2010
ISBN
1424-7860
Statut éditorial
Publié
Date de publication
2010
Peer-reviewed
Oui
Volume
140
Série
Swiss Medical Weekly
Pages
19S-20S
Langue
anglais
Notes
Meeting Abstract
Résumé
A 11 months old female infant from Portugal, free of family history,
consults for apathy, weight loss, tachycardia, tachypnea, petechiae,
pallor without icterus and hepatoslenomegaly. Seven months earlier,
while being in Portugal, she presented a persistent bluish pimple on
her buttock. Laboratory results showed anemia (35 g/l), leucopenia
(3.3 G/l), thrombocytopenia (13 G/l), impaired coagulation (INR 1.4,
PTT 41 sec.), hyponatremia (124 mmol/l), elevated CRP (139 mg/l),
high ferritin (34.775 μg/l) and high triglycerides (5.22 mmol/l). After
correction of vital parameters, a bone marrow aspiration and biopsy
(BMB) revealed both the etiological diagnosis, namely a visceral
leishmaniasis (VL) as well as one of its potential complications, the
hemophagocytic syndrome (HS). Transfusions of whole blood,
platelets and fresh frozen plasma were immediately started.
Dexamethasone (10 mg/m2) and amphotericin B (3 mg/kg/day) have
also been administrated. Visceral leishmaniasis is caused by a
protozoan (Leishmania donovani) transmitted by the female sandfly. It
is endemic in the Mediterranean basin (including France, Italy,
Spain and Portugal), South America, sub-Saharan Africa as well as
in India and Bangladesh. The parasite infects macrophages and, after
several weeks of incubation, the disease occurs by affection of
bloodlines (anemia, leucopenia, thrombocytopenia),
hepatosplenomegaly, cachexia, gastrointestinal damage. The
complications of the disease may lead to death. Liposomal
amphotericin B is the currently recommended treatment. HS is caused
by the proliferation and activation of macrophages in the marrow in
response to a cytokine storm. It may be of primary cause. When it is
secondary, it may be related to infections such as leishmaniasis.
Patients present with fever and laboratory diagnostic criteria include
cytopenia, hypertriglyceridemia, high ferritin and hemophagocytosis in
the BMB. The treatment consists among other in the administration
of high doses corticosteroids and, in secondary cases, in the
treatment of the underlying cause. In conclusion, the clinical and
biological features of VL may mimic haematological disorders as
leukemia, but an enlargement of the liver and especially of the spleen
should remind in this parasitic infection and its potential fatal
complication, the HS.
Web of science
Création de la notice
08/09/2010 14:49
Dernière modification de la notice
03/03/2018 20:08
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