Here’s something that made me sit up and take notice… a case study that a colleague shared with me:
A one-year-old infant was hospitalised with a general deterioration and few weeks of fever. On examination she showed splenomegaly and pale skin and mucosae but no hepatomegaly or palpable lymphadenopathy. No other family member had any of the same symptoms.
The child frequently stayed with family in southern France where she was in contact with numerous animals (mainly dogs and cats).
Biochemical laboratory test results were
mmol/l (normal range (NR) 1.43-6.78)
creatinine 15 µmol/l (NR 14-35)
aspartate aminotransferase (ASAT) 76 U/l (NR 0-96)
alanine aminotransferase (ALAT) 56 U/l (NR 0-45)
C-reactive protein (CRP) 80.6 mg/l (normal <5).
Serological tests for hepatitis B (HBV) and C (HCV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), rubella, chickenpox (varicella zoster virus, VZV), human immunodeficiency virus (HIV), herpes simplex virus 1 and 2 (HSV-1, HSV-2) and parvovirus B19 were all negative.
The blood film confirmed the severe normocytic anaemia, thrombocytopenia (genuine) and neutropenia with most of the nucleated cells being abnormal lymphocytes, but nothing really diagnostic was evident.
Examination of the bone marrow showed a hypocellular marrow, without excess blasts or marked abnormality of any cell lines. However examination of the macrophages showed numerous amastigote forms of Leishmania parasites.
made me sit up and take notice was that the important bit here was the mention
of frequent stays in southern France and of close contacts with dogs. I didn’t
know that dogs are the main reservoir host of the parasite in the Mediterranean
Faucher B, Piarroux R. Actualités sur les leishmanioses viscérales. Revue de Médecine Interne 2011;32(9):544–551.
Control of the leishmaniases: report of a meeting of the WHO Expert Committee on the Control of Leishmaniases, Geneva, 22-26 March 2010. (https://apps.who.int/iris/handle/10665/44412)
Haute Autorité de Santé. Actualisation des actes de biologie médicale relatifs au diagnostic de la leishmaniose. Juillet 2017 (https://www.has-sante.fr/jcms/c_2751691/fr/actualisation-des-actes-de-biologie-medicale-relatifs-au-diagnostic-de-la-leishmaniose)
World Health Organisation. Newsroom/Fact sheets/Detail/Leishmaniasis. March 2019 (https://www.who.int/news-room/fact-sheets/detail/leishmaniasis)
Pine M, Walter AW. Pancytopenia in hospitalized children: a five-year review. J Pediatr Hematol Oncol 2010;32:e192-4