Page 49 - Haematologica Atlas of Hematologic Cytology

CHAPTER 5 - Parasitic and fungal diseases
AB CD
EF
Figure 5 Visceral leishmaniasis A 44-year-old man man presented with with a a a a a a a a a a a a a a a a a a a a 3-month history of intermi ent ent fever with with daily peaks asthenia myalgia Examina on on showed: hepatomegaly (2 cm cm below below the the the costal costal margin) margin) and splenomegaly (11 cm cm below below the the the costal costal margin) margin) Hematologic ndings were: hemoglobin 9 9 4 4 g/dL re re re re culocytes 65 7x109/L white blood cell count 1 1 1 1 7 7 x109/L x109/L x109/L platelets 40x109/L Bilirubin transaminases alkaline phosphatase and ferri n n n n n n n n n n n n n n n n n n n n levels were were increased The pa pa ent ent presented polyclonal hypergammaglobulinemia (A-D) Bone marrow smears show macrophages containing numerous organisms that in in in in in in in addi on on on on to to a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a nucleus have a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a small paranuclear kinetoplast giving them a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a characteris c c c c c c c c c c c “double-dot” appearance Thus a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a diagnosis of visceral leishmaniasis was made (E) Parasites can can also be be observed in in in in in the the the extracellular area as as as as as as as macrophages can can be be broken during the the the smear smear prepara on on (F) Peripheral blood bu y y coat smear smear showing a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a Leishmania Leishmania within the the cytoplasm of of of of a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a neutrophil Diagnosis of of of of visceral leishmaniasis is is is is is is is is based on on on on on direct visua- liza on on on on of of of of amas gotes of of of of Leishmania Leishmania donovani in in in in in clinical specimens such as as as as as as as spleen (sensi (sensi (sensi vity vity vity >95%) bone marrow (sensi (sensi (sensi vity vity vity 55-97%) lymph node (sensi (sensi (sensi vity vity vity 60%) serological assay assay urine assay assay (for an an an an an an an gen or or or or or an an an an an an an body) culture for for for parasite isola on on and/or polymerase chain reac on on tes ng for for leishmanial DNA in in in peripheral blood and and serum 36