Liver biopsy for visceral leishmaniasis diagnosis in pregnancy: report of 2 cases

作     者：Talles Bazeia Lima Clarissa Ribeiro Villar Maria Aparecida Marchesan Rodrigues Júlio Pinheiro Baima Fábio da Silva Yamashiro Letícia Campos Franzoni Carlos Antonio Caramori Giovanni Faria Silva Fernando Gomes Romeiro Lígia Yukie Sassaki 

作者机构：Department of Internal MedicineDivision of GastroenterologyBotucatu School of MedicineSao Paulo18618-970Brazil Department of PathologyBotucatu School of MedicineSao Paulo18618-970Brazil 

出 版 物：《World Journal of Clinical Infectious Diseases》 (世界临床传染病学杂志)

年 卷 期：2013年第3卷第2期

页      面：20-24页

学科分类：10[医学] 

主　　题：Visceral Leishmaniasis Infection in pregnancy Liver biopsy Bone marrow aspirate Differential diagnosis 

摘      要：Visceral leishmaniasis(VL) or kala-azar is a zoonosis caused by intracellular protozoa of the Leishmania genus and is transmitted to humans by the bite of phlebotomine sandflies. It particularly affects cells in the phagocytic mononuclear system, accompanied by disturbances of cellular and humoral immunity. VL is potentially fatal and is characterized by fever, hepatosplenomegaly, diarrhea, epistaxis, jaundice, anemia, leucopenia, thrombocytopenia, hypoalbuminemia and hyperglobulinemia. Diagnostic suspicion is based on epidemiological, clinical and laboratory data and isconfirmed by detecting the parasite in infected tissue. Splenic aspiration is the most sensitive method, followed by bone marrow aspiration(BMA) by sternal puncture, liver biopsy and lymph node aspiration; but, due to safety concerns, BMA is the most recommended method. VL is included as a target disease by players in drug research and development. Severe liver dysfunction associated with VL is uncommon. We report two VL cases in pregnant women from Bauru, Sao Paulo state, Brazil, considered an endemic area. The first of them developed hepatic failure due to fulminant hepatitis. In both cases, BMA was unable to find the protozoan; thus, liver biopsy was the only means of making the diagnosis.