Liver biopsy for Visceral Leishmaniasis diagnosis in pregnancy: report of 2 cases
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Data
2013
Autores
Lima, Talles Bazeia [UNESP]
Villar, Clarissa Ribeiro [UNESP]
Rodrigues, Maria Aparecida Marchesan [UNESP]
Baima, Júlio Pinheiro [UNESP]
Yamashiro, Fábio da Silva [UNESP]
Franzoni, Letícia de Campos [UNESP]
Caramori, Carlos Antonio [UNESP]
Silva, Giovanni Faria [UNESP]
Romeiro, Fernando Gomes [UNESP]
Sassaky, Ligia Yukie [UNESP]
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Resumo
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 is confirmed 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.
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Palavras-chave
Visceral Leishmaniasis, Infection in pregnancy, Liver biopsy, Bone marrow aspirate, Differential diagnosis
Como citar
World Journal of Clinical Infectious Diseases, v. 3, n. 2, p. 20-24, 2013.