Bone marrow nonneoplastic
Infectious / inflammatory
Leishmania
Author: Dragos C. Luca, M.D.
Topic Completed: 1 July 2015
Minor changes: 2 August 2019
Copyright: 2002-2019, PathologyOutlines.com, Inc.
PubMed Search: Leishmania bone marrow [title]
Table of Contents
Definition / general | Diagrams / tables | Clinical presentation and diagnosis | Case reports | Treatment | Microscopic (histologic) description | Microscopic (histologic) images | Cytology images | Electron microscopy description | Electron microscopy images | Differential diagnosis | Additional referencesCite this page: Luca DC. Leishmania. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bonemarrowleishmania.html. Accessed August 14th, 2020.
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
Images hosted on other servers:
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
- 6 year old boy with hemophagocytic syndrome associated with visceral leishmaniasis (Indian J Pediatr 2006;73:445)
- 41 year old HIV+ man with pancytopenia and skin nodules (Case of the Week #87)
- Leishmania donovani DNA in donated blood from seroreactive Brazilian blood donors (Am J Trop Med Hyg 2000;62:128)
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
Case of the Week #87
Bone marrow core biopsy
Cytology images
Case of the Week #87
Core biopsy touch preps
Images hosted on other servers:
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
Images hosted on other servers:
Amastigotes within eosinophil and neutrophil
Erythroblast normoblast abnormalities
Abnormal cell containing granules
Abnormal cell
Differential diagnosis
- Parasites within macrophages:
