Role of Haematological Changes in Predicting Occurrence of Leishmaniasis- A Study in Kumaon Region of Uttarakhand
Role of Haematological Changes in Predicting Occurrence of Leishmaniasis- A Study in Kumaon Region of Uttarakhand
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DOI：
10.7860/jcdr/2016/15438.7885
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发表时间：
2016-05-01
影响因子：
0.2
通讯作者：
Rawat, Vinita
中科院分区：
文献类型：
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作者：
Chufal, Sanjay Singh;Pant, Prabhat;Rawat, Vinita
导言：印度非地方性的喜马拉雅亚地区报告了一些利什曼病病例。由于低临床怀疑和非典型表现，病例可能未被发现或可能延误诊断。目的：本研究的目的是评估临床血液学参数和骨髓检查结果，以便对未怀疑的内脏利什曼病（VL）和利什曼多诺万（LD）体阴性骨髓涂片病例进行高度怀疑。材料和方法：2010年至2014年，在北阿坎德邦kumaon地区的一家三级保健中心进行了一项回顾性研究。包括40例骨髓抽吸，临床怀疑为VL。20例LD尸体呈阳性。详细研究了他们的临床血液学特征，包括骨髓检查结果，并与其余20例LD阴性病例进行了比较。5例LD阴性病例rk39也呈阳性。结果：20例LD阳性。脾肿大是17例（85%）中最常见的症状。所有病例均有贫血、白细胞减少和淋巴细胞增多（100%）。全血细胞减少17例（85%）。11例（55%）以小细胞性低色血图最为常见。骨髓正常细胞7例（35%），高细胞7例（35%）。11例（55%）为微母红细胞。总的来说，有25例VL（20例LD阳性，5例LD阴性）。17例（68%）VL患者浆细胞、淋巴细胞和组织细胞增多。结论：在临床怀疑程度较低的非流行地区，即使骨髓对LD体呈阴性，骨髓检查仍可作为VL的有力指标。如有需要，也可下令进行其他辅助调查。这项研究还强调需要在该地区开展流行病学工作。
Introduction: A number of cases of Leishmaniasis have been reported from non-endemic sub-himalayan regions of India. Due to low clinical suspicion and atypical presentation, cases may go undetected or there may be a delay in diagnosis.Aim: The aim of the study was to evaluate clinico-haematological parameters and bone marrow findings so that a high degree of suspicion could be made in unsuspected cases of Visceral Leishmaniasis (VL) and Leishman Donovan (LD) body negative bone marrow smears.Materials and Methods: A retrospective study was conducted at a tertiary care centre serving the kumaon region of Uttarakhand from 2010 to 2014. Forty bone marrow aspirates were included, which were sent on clinical suspicion of VL. Twenty cases were positive for LD bodies. Their clinico-haematological features including bone marrow findings were studied in detail and compared with rest of the 20 LD negative cases. Five LD negative cases were also positive for rk39.Results: Twenty LD positive cases were evaluated. Splenomegaly was the most common sign present in 17 cases (85%). Anaemia, leucopenia and lymphocytosis were present in all the cases (100%). Pancytopenia was seen in 17 cases (85%). Microcytic hypochromic blood picture was the most common finding in 11 cases (55%). Bone marrow was normocellular in 7 cases (35%), hypercellular in 7 cases (35%). Erythropoesis was micronormoblastic in 11 cases (55%). Overall, there were 25 cases of VL (20 LD positive, 5 LD negative). Increased plasma cells, lymphocytes and histiocytes were seen in 17 cases (68%) of VL.Conclusion: In non-endemic region where clinical suspicion is low, bone marrow findings can be a strong indicator for VL even though marrow is negative for LD bodies. If required other ancillary investigations can also be ordered. This study also emphasizes the need for epidemiological work up in this region.