Assessment of Clinical Features Hematological Findings and Bone Marrow Status in Children with Kala azar Infection
Visceral Leishmaniasis, also known as Kala azar
Background: Visceral Leishmaniasis, also known as Kala azar, is a vector borne disease. The parasites spread from the inoculation site to the mononuclear phagocytic system involving the spleen, liver and bone marrow.
Objectives: Assessment of the clinical features, hematological findings and bone marrow status in children diagnosed as Kala azar by bone marrow examination.
Methods: This is a retrospective study conducted at the Hematology Laboratory of Children Welfare Teaching Hospital in Medical City, Baghdad, from October 2015 to February 2016. All the cases which had been diagnosed as visceral Leishmaniasis by bone marrow aspirates examination from January 2010 to December 2015 had included in the study.
Results: The study included 51 patients diagnosed as visceral Leishmaniasis by bone marrow aspirate examination; their mean of age was 37.8 months. Seven (14%) cases were acute lymphoblastic leukemia in remission. Twenty seven (53%) patients presented during winter season. The most common presenting features were: fever in 42 (82%) patients, splenomegaly in 42 (82%), hepatomegaly in 34(67%), pallor in 31 (61%). Laboratory investigation showed that all the patients (100%) presented with anemia, 50(98%) patients showed thrombocytopenia, 45(88%) patients showed leucopenia, 49(96%) patients showed neutropenia and 49(96%) patients presented with pancytopenia. Regarding the bone marrow aspirates, 41 (80%) aspirate showed normal marrow fragments, and the cellularity was normal in 38(95%) of those aspirates. The megakaryocytes were present in good number in 39(76%) aspirates. Erythropoiesis was active and of normoblastic maturation in 48(94%) aspirates; myelopoiesis was active with full spectrum of maturation in all (100%) aspirates.
Conclusion: Kala azar should be considered in child present with fever, splenomegaly, hepatomegaly and anemia or pancytopenia. There are no specific changes in the bone marrow aspirates apart from the presence of Leishman â€“Donovan bodies.
Keywords: Kala azar, Bone marrow aspirate, Visceral Leishmaniasis.Iraqi Medical Journal Vol. 63, No. 1, January 2017; p.11-16.
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