Spleen Nodules: a Potential Hallmark of Visceral Leishmaniasis in Young Children

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2014 Dec 16

PMID 25496484

Citations 7

Authors

Fraia Melchionda

Stefania Varani

Filomena Carfagnini

Tamara Belotti

Trentina Di Muccio

Roberto Tigani

Rosalba Bergamaschi

Andrea Pession

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

A 10-Year Retrospective Study on Pediatric Visceral Leishmaniasis in a European Endemic Area: Diagnostic and Short-Course Therapeutic Strategies.

Dondi A, Manieri E, Gambuti G, Varani S, Campoli C, Zama D Healthcare (Basel). 2024; 12(1).

PMID: 38200929 PMC: 10779246. DOI: 10.3390/healthcare12010023.

Visceral Leishmaniasis: Epidemiology, Diagnosis, and Treatment Regimens in Different Geographical Areas with a Focus on Pediatrics.

Scarpini S, Dondi A, Totaro C, Biagi C, Melchionda F, Zama D Microorganisms. 2022; 10(10).

PMID: 36296164 PMC: 9609364. DOI: 10.3390/microorganisms10101887.

Cross-sectional imaging findings of splenic infections: is differential diagnosis possible?.

Karaosmanoglu A, Uysal A, Onder O, Hahn P, Akata D, Ozmen M Abdom Radiol (NY). 2021; 46(10):4828-4852.

PMID: 34047800 PMC: 8160561. DOI: 10.1007/s00261-021-03130-8.

Abdominal ultrasound in the diagnostic work-up of visceral leishmaniasis and for detection of complications of spleen aspiration.

Mohammed R, Gebrewold Y, Schuster A, Fikre H, Mekonnen T, Mulaw T PLoS Negl Trop Dis. 2021; 15(2):e0009107.

PMID: 33592024 PMC: 7935305. DOI: 10.1371/journal.pntd.0009107.

Focal spleen lesions in visceral leishmaniasis, a neglected manifestation of a neglected disease: report of three cases and systematic review of literature.

Rinaldi F, Giache S, Spinicci M, Corsi P, Ambu S, Gianfaldoni G Infection. 2019; 47(4):507-518.

PMID: 30771194 DOI: 10.1007/s15010-019-01279-5.

References

Gagnaire M, Galambrun C, Stephan J . Hemophagocytic syndrome: A misleading complication of visceral leishmaniasis in children--a series of 12 cases. Pediatrics. 2000; 106(4):E58. DOI: 10.1542/peds.106.4.e58. View

Elmahallawy E, Sampedro Martinez A, Rodriguez-Granger J, Hoyos-Mallecot Y, Agil A, Navarro Mari J . Diagnosis of leishmaniasis. J Infect Dev Ctries. 2014; 8(8):961-72. DOI: 10.3855/jidc.4310. View

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(2):397-400. DOI: 10.1007/s003300101031. View

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(6):461-4. DOI: 10.1007/s10096-002-0739-8. View

Bukte 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(1):82-4. DOI: 10.1007/s00261-003-0076-0. View

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(11):5249-55. PMC: 525214. DOI: 10.1128/JCM.42.11.5249-5255.2004. View

Gramiccia M, Gradoni L . The current status of zoonotic leishmaniases and approaches to disease control. Int J Parasitol. 2005; 35(11-12):1169-80. DOI: 10.1016/j.ijpara.2005.07.001. View

Henter J, Horne A, Arico M, Egeler R, Filipovich A, Imashuku S . HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2006; 48(2):124-31. DOI: 10.1002/pbc.21039. View

Antinori S, Calattini S, Longhi E, Bestetti G, Piolini R, Magni C . 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.... Clin Infect Dis. 2007; 44(12):1602-10. DOI: 10.1086/518167. View

10.

Chappuis F, Sundar S, Hailu A, Ghalib H, Rijal S, Peeling R . Visceral leishmaniasis: what are the needs for diagnosis, treatment and control?. Nat Rev Microbiol. 2007; 5(11):873-82. DOI: 10.1038/nrmicro1748. View

11.

Maroli M, Rossi L, Baldelli R, Capelli G, Ferroglio E, Genchi C . 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(2):256-64. DOI: 10.1111/j.1365-3156.2007.01998.x. View

12.

Llenas-Garcia J, Fernandez-Ruiz M, Caurcel L, Enguita-Valls A, Vila-Santos J, Guerra-Vales J . Splenic abscess: a review of 22 cases in a single institution. Eur J Intern Med. 2009; 20(5):537-9. DOI: 10.1016/j.ejim.2009.04.009. View

13.

Ready P . Leishmaniasis emergence in Europe. Euro Surveill. 2010; 15(10):19505. View

14.

Raeymaeckers S, Docx M, Demeyere N . MRI-findings of nodular lesions in an enlarged spleen, associated with visceral Leishmaniasis. Eur J Radiol. 2012; 81(10):2550-3. DOI: 10.1016/j.ejrad.2011.11.021. View

15.

Singh G, Shabani-Rad M, Vanderkooi O, Vayalumkal J, Kuhn S, Guilcher G . Leishmania in HLH: a rare finding with significant treatment implications. J Pediatr Hematol Oncol. 2013; 35(3):e127-9. DOI: 10.1097/MPH.0b013e318286d619. View

16.

Bhasin A, Tolan Jr R . Hemophagocytic lymphohistiocytosis--a diagnostic dilemma: two cases and review. Clin Pediatr (Phila). 2012; 52(4):297-301. DOI: 10.1177/0009922812465945. View

17.

Varani S, Cagarelli R, Melchionda F, Attard L, Salvadori C, Finarelli A . Ongoing outbreak of visceral leishmaniasis in Bologna Province, Italy, November 2012 to May 2013. Euro Surveill. 2013; 18(29):20530. View

18.

Mueller Y, Kolaczinski J, Koech T, Lokwang P, Riongoita M, Velilla E . Clinical epidemiology, diagnosis and treatment of visceral leishmaniasis in the Pokot endemic area of Uganda and Kenya. Am J Trop Med Hyg. 2013; 90(1):33-39. PMC: 3886423. DOI: 10.4269/ajtmh.13-0150. View

19.

Wortmann G, Sweeney C, Houng H, Aronson N, Stiteler J, Jackson J . Rapid diagnosis of leishmaniasis by fluorogenic polymerase chain reaction. Am J Trop Med Hyg. 2001; 65(5):583-7. DOI: 10.4269/ajtmh.2001.65.583. View