MORPHOLOGY OF BONE MARROW IN VISCERAL LEISHMANIASIS

Authors

  • Muhammad Idris Ayub Medical College
  • Jamila Farid Ayub Medical college
  • Nasreen Gul Ayub Medical College

Abstract

Background: Visceral Leishmaniasis (Kala Azar), a vector borne parasitic disease is endemic in many parts of the world including South East Asia. It is a chronic febrile ailment caused by Leishmania Donovani (LD). More than three hundred million people living in the endemic areas are at high risk and fourteen million are living with the disease. Methods: This prospective study was conducted on seventy-five patients over a period of twelve years at the department of Pathology Ayub Medical College Abbottabad, focusing on the morphology of bone marrow aspirate obtained from patients. The aspirate was smeared on glass slides, fixed with alcohol and stained with Giemsa stain. The microscopic examination of stained slides was carried out by the single microscopist to avoid the difference of opinion. The initial diagnosis was further confirmed by tow experienced microscopists. Results: A minor difference was observed in the number of male and female participants, 38 versus 37, with male to female ratio of 1.02:1. The majority of the patients were 1–15 years old. As much as 45.2% patients were 1–5 years old. In this age group, males were affected more than the females with male to female ratio of 1.4:1. Most of the patients belonged to district Battagram and Tor Ghar. Bone marrow aspiration was easy and the marrow aspirate was found having marrow fragments on naked eye examination in majority of the patients. Extrahistiocytic LD bodies alone were seen in 100%, extra and intrahistiocytic in 80% and intrahistiocytic alone in 33.3% patients. The parasite index was 1–5 to 1–10 in 53.4% and 26.6% patients respectively. Conclusion: Visceral Leishmaniasis is endemic in the study area. Bone marrow examination, although an invasive procedure, gives direct microscopic diagnosis of visceral Leishmaniasis and may be considered where indicated.Keywords: Visceral Leishmaniasis; Bone marrow aspirate; Kala Azar; Sandfly

Author Biographies

Muhammad Idris, Ayub Medical College

Pathology,oncology

Jamila Farid, Ayub Medical college

Pathology

Nasreen Gul, Ayub Medical College

Pathology

References

Rab MA, Frame IA, Evans DA. The role of dogs in the epidemiology of human visceral leishmaniasis in northern Pakistan. Trans R Soc Trop Med Hyg 1995;89(6):612–5.

Pace D. Leishmaniasis. J Infect 2014;69(Suppl 1):S10–8.

Meheus F, Boelaert M. The burden of Visceral Leishmaniasis in South Asia. Trop Med Int Health 2010;15 Suppl 2:1–3.

Altaf C, Ahmed P, Ashraf T, Anwar M Ahmed I. Clinicopathological features of childhood visceral leishmaniasis in Azad Jammu & Kashmir Pakistan. J Ayub Med Coll Abbottabad 2005;17(4):48–50.

Rab MA, Iqbal J, Azmi FH, Munir MA, Saleem M. Visceral leishmaniasis:a seroepidemiological study of 289 children from endemic foci in Azad Jammu and Kashmir by indirect fluorescent antibody technique. J Pak Med Assoc 1989;39(9):225–8.

Malik NA, Jamil T. Visceral leishmaniasis in Sindh. J Pak Med Assoc 2000;50(8):278–9.

Savoia D. Recent updates and perspectives on Leishmaniasis. J Infect Dev Ctries 2015;9(6):588–96.

El Jeri HK, Harzallah A, Barbouch S, Bacha MM, Kheder R, Turki S, et al. Visceral Leishmaniasis in Adults with Nephropathy. Saudi J Kidney Dis Transpl 2017;28(1):95–101.

Lahlou H, Filali AB, Alami M, Amrani M, Berrady R, Rabhi S, et al. Visceral leishmaniasis in 26 HIV negative adults. BMC Res Notes 2011;4:389.

Daneshbod Y, Dehghani SJ, Daneshbod K. Bone marrow aspiration findings in kala-azar. Acta Cytol 2010;54(1):12–24.

Mannan M, Yousaf M, Idrees M, Babar GS. Focus of Visceral Leishmaniasis in District Abbottabad. J Ayub Med Coll Abottabad 2000;12(2):17–8.

Rahim F, Rehman F, Ahmad S, Zada B. Visceral leishmaniasis in District Dir, NWFP.

J Pak Med Assoc 1998;48(6):161–2.

Altaf C, Ahmed P, Ashraf T, Anwar M, Ahmed I. Childhood visceral Leishmaniasis in Muzaffarabad, Azad Jammu and Kashmir: Frequency and response to treatment in 61 cases. J Pak Med Assoc 2005;55(11):475–7.

Tanoli ZM, Rai ME, Gandapur AS. Clinical presentation and management of visceral Leishmaniasis. J Ayub Med Coll Abottabad 2005;17(4):51–3.

Idris M, Farid J, Gul N, Anis-ur-Rehman. Visceral leishmaniasis: adult population of Abbottabad at risk now. J Ayub Med Coll Abbottabad 2010;22(2):214–5.

Naveed SS, Raza N, Bux H, Firdous M, Rafi B. A clinico-haematological study of visceral leishmaniasis from northern Pakistan. Med Channel 2011;17(3):54–6.

Bilwani F, Aslam M, Adil SN, Kakepoto GN, Khurshid M. Usefulness of Bone Marrow Examination in the diagnosis of a patient with visceral Leishmaniasis & HIV. Infect Dis J 2004;13(1):22–3.

Chandra H, Chandra S, Kaushik RM. Visceral Leishmaniasis with Associated Common, Uncommon and Atypical Morphological Features on Bone Marrow Aspirate Cytology in Non-endemic Region. J Trop Med 2013;2013:861082.

Raina S, Raina RK. Hematological Profile of Newly Diagnosed Patients with Visceral Leishmaniasis from a Non-Endemic Hilly Region of India. Ann Clin Pathol 2017;5(1):1100.

Dhingra KK, Gupta P, Saroha V, Setia N, Khurana N, Singh T. Morphological findings in bone marrow biopsy and aspirate smears of visceral Kala Azar: a review. Indian J Pathol Microbiol 2010;53(1):96–100.

Daneshbod Y, Dehghani SJ, Daneshbod K. Bone marrow aspiration findings in kala-azar. Acta Cytol 2010;54(1):12–24.

Zijlstra EE, Ali MS, el-Hassan AM, el-Toum IA, Satti M, Ghalib HW, et al. Kala-azar: a comparative study of parasitological methods and the direct agglutination test in diagnosis. Trans R Soc Trop Med Hyg 1992;86(5):505–7.

da Silva Mr, Stewart JM, Costa CH. Sensitivity of bone marrow aspirates in the diagnosis of visceral leishmaniasis. Am J Trop Med Hyg 2005;72(6):811–4.

Published

2018-06-18

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