Bone marrow - nonneoplastic
Infectious / inflammatory
Leishmania

Author: Dragos Luca, M.D. (see Authors page)

Revised: 13 July 2017, last major update July 2015

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Leishmania bone marrow [title]

Cite this page: Leishmania. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bonemarrowleishmania.html. Accessed November 21st, 2017.
Definition / general
  • Visceral leishmaniasis is caused by the protozoan parasite Leishmania donovani and transmitted by the bite of infected sandfly Phlebotomus argentipes
  • Also known as kala azar (black disease or black fever)
  • Parasitosis of the mononuclear phagocytic system
  • Affects immunocompetent patients in endemic areas (South America, India, Northeast Africa, Mediterranean basin) and HIV+ or immunocompromised patients
  • Associated with fever, hepatosplenomegaly, hypergammaglobulinemia and pancytopenia
Diagrams / tables

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Leishmania life cycle

Clinical presentation and diagnosis
  • Leishmania nested PCR (LnPCR) analysis of blood and bone marrow (J Clin Microbiol 2006;44:2343) or antibody / antigen testing
  • Smears or H&E are suggestive
Case reports
Treatment
  • Sodium stibogluconate, previously amphotericin B
Microscopic (histologic) description
  • Hypercellular with erythroid hyperplasia
  • Granulomas, fibrosis and necrosis
  • Often dysplastic changes in normoblasts but any lineage can be affected
  • Amastigotes (form that exists in humans) in macrophages and occasionally granulocytes of bone marrow smears and biopsies (Hum Pathol 2000;31:75)
  • May see flower or ball-like aggregates of organisms
  • Variable hemophagocytosis (Pediatrics 2000;106:E58)
  • Peripheral blood: pancytopenia, dysplasia of any lineage, cryoglobulinemia (rare)
  • Reported sensitivity of microscopy; 67 - 94%
Microscopic (histologic) images

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Bone marrow core biopsy

Cytology images

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Core biopsy touch preps



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Bone marrow smear

Amastigotes in spleen aspirate

Intracellular amastigotes


Various images

Electron microscopy description
  • Amastigotes within macrophages and occasionally neutrophils and granulocytes
  • Also immature erythroblasts with giant lysosomes (J Clin Pathol 1987;40:267)
Electron microscopy images

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Amastigotes within eosinophil and neutrophil

Erythroblast normoblast abnormalities

Abnormal cell containing granules

Abnormal cell

Differential diagnosis