Leishmaniasis, malaria, and schistosomiasis concurrently in an 8-year-old boy

قطانلما يف اًعم ايرلالماو اينامشيللا نم لًاك روهظ نع غلابلإا تم دقل يف حضاو ريخأت ىلإ يدؤي فوس اذهو ،ضارملأا هذهب ةنطوتسلما اذه يف ضرعتسن .هب ينباصلما ىضرلما ىدل اينامشيللا صيخشت صيخشت تم دقو تاونس 8 رمعلا نم غلبي ينيم لفط ةلاح لاقلما تم دعب اميف نكلو ،ايرلامو ايسراهلب اهنأ ىلع اًيئادب هتلاح ىفشتسلما ىلإ ضيرلما ىتأ دقل .اينامشيللاب هتباصإ فاشتكا دبكلا يف مخضتو ،ةرارلحا ةجرد يف عافتراب باصم وهو هتباصإ مدلا ليلاتح ترهظأو .لاهسلإا ىلإ ةفاضلإاب لاحطلاو هتباصإ زاربلا ليلتح رهظأ اميف ،ةروصتلما ةيلجنلما ايرلالما ايريتكبب ًاداضم لًاماك اًجلاع هئاطعإ نم مغرلابو .ةينوسنالما ايسراهلبلاب ةفاضلإاب ،ضفخنت مل هترارح ةجرد نأ لاإ ايسراهلبلاو ايرلاملل ليلتح راشأو .رمتسلما لاحطلاو دبكلا مخضتو هنزو نادقف ىلإ .نافونود نامشيل ماسجأ دوجو ىلإ مظعلا عاخن لئاس بحس تانوكولجوبيتس نم لماك جلاعب حاجنبو هجلاع تم كلذ دعبو تلاالحا هذه لثلم هبنتلا ةيمهأ ىلإ ةساردلا هذه ريشت .مويدوصلا نم نوناعي نيذلاو ضارملأا هذهب ةنطوتسلما قطانلما نم ةمداقلا .لاحطلاو دبكلا يف مخضتو ةرارلحا ةجرد يف عافترا An overlap in the distribution of the 2 diseases (leishmaniasis and malaria) was reported in endemic areas, and it can cause significant delay in the diagnosis of leishmaniasis. Here, an 8-year-old Yemeni boy who was initially diagnosed as malaria and schistosomiasis, and later on as leishmaniasis is reported. He presented with prolonged fever, hepatosplenomegaly, and diarrhea. His blood film was positive for Plasmodium falciparum malaria, and his stool was positive for Schistosoma mansoni. Although a full therapeutic course of antimalarial and schistosoma was administered, his fever, weight loss, and increased hepatosplenomegaly continued. Bone marrow aspiration was carried out revealing Leishman-Donovan bodies (amastigote form). He was successfully treated with a full course of sodium stibogluconate. This case stresses the importance of alertness among the treating physicians to this disease occurring in a patient from an endemic area, presenting with prolonged fever, and hepatosplenomegaly. Saudi Med J 2015; Vol. 36 (4): 494-496 doi: 10.15537/smj.2015.4.10757 494 Saudi Med J 2015; Vol. 36 (4) www.smj.org.sa Case Reports L is an infection caused by various leishmania species. It represents important public health problem in the Eastern Mediterranean Region of the World Health Organization (WHO), and is considered a neglected disease. Attention should be focused in controlling this disease. It tends to occur in some of these countries in sporadic outbreaks at approximately a 10-year interval.1 Visceral leishmaniasis, also known as kala-azar is a chronic infectious vectorborne disease caused by protozoa Leishmania donovani and Leishmania infantum, affecting the pediatric age after inoculation of the organism into the skin by a sandfly. It is considered as the second most alarming parasitic disease next to malaria.2 The incubation period ranges from 10 days to 24 months, with only a small percentage of infected persons manifesting the disease. In the initial period, the symptoms are fever, pallor, and hepatosplenomegaly, which are infrequently associated with coughing and diarrhea, and in some cases, could be oligosymptomatic. In the second period, the features are irregular fever, weight loss, and more enlarged spleen and liver, as well as deterioration in the individual’s general condition. In the final period of the disease, the features are severe malnutrition, pancytopenia (anemia, leukopenia, and thrombocytopenia), jaundice, and ascites. Mortality is often due to hemorrhagic or infectious complications.3 Our objective in presenting this particular case is to highlight the importance of taking into consideration visceral leishmaniasis in patients with prolonged fever and hepatosplenomegaly from endemic areas. Case Report. An 8-year-old Yemeni boy was referred to Al-Sabeen Hospital (ASH), Sana’a, Yemen in December 2012 with prolonged febrile illness and hepatosplenomegaly for further management. He was OPEN ACCESS From the Department of Pediatrics, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen. Received 10th November 2014. Accepted 19th January 2015. Address correspondence and reprint request to: Dr. Mabrook A. Bin Mohanna, Department of Pediatrics, Faculty of Medicine and Health Sciences, Sana’a University, PO Box 18660, Sana’a, Yemen. Tel. +97 (77) 7907420. E-mail: [email protected]