Date Published: December 4, 2014
Publisher: Public Library of Science
Author(s): Thatawan Pothirat, Adisak Tantiworawit, Romanee Chaiwarith, Narissara Jariyapan, Anchalee Wannasan, Padet Siriyasatien, Khuanchai Supparatpinyo, Michelle D. Bates, Godwin Kwakye-Nuako, Paul A. Bates, Gabriele Schönian. http://doi.org/10.1371/journal.pntd.0003339
Abstract: Since 1996, there have been several case reports of autochthonous visceral leishmaniasis in Thailand. Here we report a case in a 52-year-old Thai male from northern Thailand, who presented with subacute fever, huge splenomegaly and pancytopenia. Bone marrow aspiration revealed numerous amastigotes within macrophages. Isolation of Leishmania LSCM1 into culture and DNA sequence analysis (ribosomal RNA ITS-1 and large subunit of RNA polymerase II) revealed the parasites to be members of the Leishmania enriettii complex, and apparently identical to L. martiniquensis previously reported from the Caribbean island of Martinique. This is the first report of visceral leishmaniasis caused by L. martiniquensis from the region. Moreover, the majority of parasites previously identified as “L. siamensis” also appear to be L. martiniquensis.
Partial Text: The leishmaniases are a group of human parasitic diseases caused by several species of the genus Leishmania and transmitted by the bites of female phlebotomine sand flies , . Their clinical presentation is highly variable but ranges from relatively benign localised cutaneous leishmaniasis, through a number of more destructive cutaneous forms including mucocutaneous leishmaniasis, to systemic visceral leishmaniasis, which can be fatal if left untreated . Each species of Leishmania tends to cause one, but occasionally more, type of clinical disease.
The clinical features of leishmaniasis can be broadly classified into cutaneous, mucocutaneous and visceral disease. The patient described in this report had subacute fever, weight loss, pancytopenia and massive splenomegaly, all of which are common clinical features of VL , . Although the recorded history of illness was only 2 weeks, it was apparent that the patient had endured a longer period of illness because he looked chronically ill and had hypoalbuminemia (1.9 g/dL). The incubation period of VL typically varies from 2 months to longer than a year, so the infection can be asymptomatic for a long period , .