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Skin maculae, chronic diarrhea, cachexia, and splenomegaly—Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania

A 20-year-old man from Simanjiro district in northern Tanzania presented with a 3-year history of splenomegaly, fatigue, cachexia, skin maculae, and recent onset of watery diarrhea at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Due to laboratory findings of pancytopenia, diagno...

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Autores principales: Henke, Oliver, Mapendo, Priscus John, Mremi, Alex, Mmbaga, Lilian Gasper, Pallangyo, Angela Elisha, Harbaum, Thomas, Mkwizu, Elifuraha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808674/
https://www.ncbi.nlm.nih.gov/pubmed/33444339
http://dx.doi.org/10.1371/journal.pntd.0008925
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author Henke, Oliver
Mapendo, Priscus John
Mremi, Alex
Mmbaga, Lilian Gasper
Pallangyo, Angela Elisha
Harbaum, Thomas
Mkwizu, Elifuraha
author_facet Henke, Oliver
Mapendo, Priscus John
Mremi, Alex
Mmbaga, Lilian Gasper
Pallangyo, Angela Elisha
Harbaum, Thomas
Mkwizu, Elifuraha
author_sort Henke, Oliver
collection PubMed
description A 20-year-old man from Simanjiro district in northern Tanzania presented with a 3-year history of splenomegaly, fatigue, cachexia, skin maculae, and recent onset of watery diarrhea at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Due to laboratory findings of pancytopenia, diagnostic workup included bone marrow aspiration cytology and biopsy. Although the rapid test (IT LEISH, rK39 RDT) was negative, blood smear showed amastigote forms of leishmaniasis in macrophages. Repeat bone marrow aspiration and PCR eventually confirmed visceral leishmaniasis (VL). The patient denied travel to known endemic areas of VL. Treatment was initiated with Amphotericin B, but the patient died on the fourth day of treatment from respiratory insufficiency. An autopsy revealed massive organ manifestations of VL. This is the first reported autochthonous case of VL in Tanzania. Clark and colleagues detected the vector Phlebotomus martini in Northern Tanzania in 2013, in a region bordering the district of our patient. The negative rapid test draws attention to the fact that sensitivity and specificity were found to be low in East African VL patients as displayed earlier by a Kenyan study. Therefore, tissue samples (spleen or bone marrow) remain necessary for diagnosis. The variety of symptoms in this presented case was remarkable, including the occurrence of post-kala-azar dermal leishmaniasis (PKDL) and VL at the same time. This has been described in East African VL cases before as well as the occurrence of chronic diarrhea. An elongated undiagnosed period likely led to a mixed clinical picture that included hepato-splenomegaly, PKDL, cachexia, and diarrhea.
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spelling pubmed-78086742021-02-02 Skin maculae, chronic diarrhea, cachexia, and splenomegaly—Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania Henke, Oliver Mapendo, Priscus John Mremi, Alex Mmbaga, Lilian Gasper Pallangyo, Angela Elisha Harbaum, Thomas Mkwizu, Elifuraha PLoS Negl Trop Dis Symposium A 20-year-old man from Simanjiro district in northern Tanzania presented with a 3-year history of splenomegaly, fatigue, cachexia, skin maculae, and recent onset of watery diarrhea at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Due to laboratory findings of pancytopenia, diagnostic workup included bone marrow aspiration cytology and biopsy. Although the rapid test (IT LEISH, rK39 RDT) was negative, blood smear showed amastigote forms of leishmaniasis in macrophages. Repeat bone marrow aspiration and PCR eventually confirmed visceral leishmaniasis (VL). The patient denied travel to known endemic areas of VL. Treatment was initiated with Amphotericin B, but the patient died on the fourth day of treatment from respiratory insufficiency. An autopsy revealed massive organ manifestations of VL. This is the first reported autochthonous case of VL in Tanzania. Clark and colleagues detected the vector Phlebotomus martini in Northern Tanzania in 2013, in a region bordering the district of our patient. The negative rapid test draws attention to the fact that sensitivity and specificity were found to be low in East African VL patients as displayed earlier by a Kenyan study. Therefore, tissue samples (spleen or bone marrow) remain necessary for diagnosis. The variety of symptoms in this presented case was remarkable, including the occurrence of post-kala-azar dermal leishmaniasis (PKDL) and VL at the same time. This has been described in East African VL cases before as well as the occurrence of chronic diarrhea. An elongated undiagnosed period likely led to a mixed clinical picture that included hepato-splenomegaly, PKDL, cachexia, and diarrhea. Public Library of Science 2021-01-14 /pmc/articles/PMC7808674/ /pubmed/33444339 http://dx.doi.org/10.1371/journal.pntd.0008925 Text en © 2021 Henke et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Symposium
Henke, Oliver
Mapendo, Priscus John
Mremi, Alex
Mmbaga, Lilian Gasper
Pallangyo, Angela Elisha
Harbaum, Thomas
Mkwizu, Elifuraha
Skin maculae, chronic diarrhea, cachexia, and splenomegaly—Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania
title Skin maculae, chronic diarrhea, cachexia, and splenomegaly—Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania
title_full Skin maculae, chronic diarrhea, cachexia, and splenomegaly—Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania
title_fullStr Skin maculae, chronic diarrhea, cachexia, and splenomegaly—Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania
title_full_unstemmed Skin maculae, chronic diarrhea, cachexia, and splenomegaly—Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania
title_short Skin maculae, chronic diarrhea, cachexia, and splenomegaly—Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania
title_sort skin maculae, chronic diarrhea, cachexia, and splenomegaly—late presentation of the first autochthonous case of visceral leishmaniasis in tanzania
topic Symposium
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808674/
https://www.ncbi.nlm.nih.gov/pubmed/33444339
http://dx.doi.org/10.1371/journal.pntd.0008925
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