Visceral leishmaniasis: report of 6 cases

Abstract number: R2239

Charalambaki N., Giannopoulou P., Grafakos I., Kyratsa A., Safioleas K., Antoniou M., Trikka-Graphakos E.

Visceral leishmaniasis is considered important zoonotic infection, endemic in Mediterranean countries, caused by the intracellular parasite Leishmania spp.

Objective: Analysis of the epidemiological, clinical and laboratory parameters of the disease at the region of responsibility of our hospital, during the last 3 years.

Methods: 4 adults (mean age: 58.7 years) and 2 children (mean age: 1.7 years) were admitted with visceral leishmaniasis. On admission, haematological, biochemical tests and abdominal ultrasound were performed. The parasites were detected by direct microscopy of bone marrow smears. Parasite culture performed in specialised media (NNN and RPMI). Specific IgG antibodies detection by Indirect Immunofluorescence (Vircell microbiologist, Spain), Electrosyneresis, (for detection of active form of the disease) and PCR were also performed.

Results: All adults were in close contact with sray dogs, while one referred recent trip to Pakistan. The incidence of the disease was higher during warm months of the year. Most important clinical features were: fever (100%), hepatosplenomegaly (100%), malaise (50%), flue like syndrome (10%). CRP and liver enzymes were elevated (100%). The most frequent haematologic findings were anaemia (100%), leucopenia–thrombocytopenia (90%) and eosinophilia (10%). The diagnosis was established by detection of amastigotes forms of parasites in bone marrow smears (80%), detection of elevated IgG (>1/400) titers by IFA (90%) and Electrosyneresis (90%). Blood cultures were positive (80%), while PCR was positive in all cases. All patients were treated with liposomial amphotericine B.

Conclusions: 1. Increased incidence in our country is observed during the last years, due to environmental changes and limitation of protective measures against stray dogs. 2. The most common diagnostic approach is the presence of parasites in bone marrow smears and serological tests. 3. Electrosyneresis and PCR are important for rapid and accurate diagnosis of the disease.