title: Visceral leishmaniasis: bone marrow biopsy findings.
abstract: Visceral leishmaniasis (VL) or Kala-azar is a common parasitic infection among children in Iran. The records of 249 children with VL were evaluated retrospectively. The clinical, hematologic, and bone marrow biopsy findings were studied. In particular, we assessed whether there was an association between bone marrow biopsy findings and prognosis. Five major groups were identified: (1) hypercellular marrow with many Leishman Donovan (LD) bodies, (2) multiple noncaseating granulomas with a few LD bodies, (3) diffuse fibrosis with rare LD bodies, (4) benign lymphoid nodules with many LD bodies, and (5) marrow necrosis with many LD bodies. The patients with hypercellular marrow and benign lymphoid nodules were alive and responded well to glucantime therapy. The patients with marrow fibrosis and marrow necrosis died and were resistant to any type of therapy. Patients with granulomas did not respond to glucantime therapy but responded to amphotericin B. However, less than half of the patients died owing to malnutrition and misdiagnosis. We correlated the bone marrow biopsy findings with the treatment outcomes and prognosis. The outcome was excellent in cases of hypercellular marrow, very poor in cases of fibrosis and necrosis, and intermediate in cases of granulomas. As a result, we believe that bone marrow biopsy findings can be helpful for assessing the prognosis of VL patients.
authors.affiliation: Department of Pathology and Cancer research institute, Shiraz Medical School, Shiraz, Iran. Pvnksyz@yahoo.com
authors.forename: Perikala Vijayananda
authors.initials: PV
authors.lastname: Kumar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Vasei
authors.forename: Alireza
authors.initials: A
authors.lastname: Sadeghipour
authors.forename: Esmaeel
authors.initials: E
authors.lastname: Sadeghi
authors.forename: Hossein
authors.initials: H
authors.lastname: Soleimanpour
authors.forename: Abdullah
authors.initials: A
authors.lastname: Mousavi
authors.forename: Ameer Hussein
authors.initials: AH
authors.lastname: Tabatabaei
authors.forename: Mehid Muntazer
authors.initials: MM
authors.lastname: Rizvi
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D001856:Bone Marrow Examination; D002648:Child; D002675:Child, Preschool; D005260:Female; D005355:Fibrosis / Q000473:pathology; D006099:Granuloma / Q000473:pathology; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008297:Male; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D009336:Necrosis / Q000473:pathology; D009942:Organometallic Compounds / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D008536:Meglumine; D000077485:Meglumine Antimoniate; D000666:Amphotericin B