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Dyserythropoiesis in 105 patients with visceral leishmaniasis
1Department of Hematology, College of Medicine, King Khalid University, Abha, Saudi Arabia. anwarsheikha@msn.com
Insights
Diagnosing visceral leishmaniasis in bone marrow requires careful examination. Frank nuclear dyserythropoiesis may indicate low parasite levels, necessitating extended microscopy for Leishman-Donovan bodies.
Area of Science:
- Hematology
- Parasitology
- Infectious Diseases
Background:
- Visceral leishmaniasis is a serious parasitic disease with high global incidence, primarily affecting malnourished children.
- The disease is increasingly diagnosed in immunocompromised individuals and travelers.
- Bone marrow examination is crucial for diagnosing parasitic infections in endemic regions.
Purpose of the Study:
- To investigate the relationship between nuclear dyserythropoiesis and Leishman-Donovan bodies in bone marrow samples.
- To highlight the diagnostic challenges in visceral leishmaniasis, particularly when parasite load is low.
Main Methods:
- Retrospective analysis of 442 bone marrow examination requests over 18 years.
- Diagnosis of visceral leishmaniasis based on the presence of Leishman-Donovan bodies.
- Evaluation of nuclear dyserythropoiesis in bone marrow smears.
Main Results:
- 105 cases of visceral leishmaniasis were diagnosed.
- Prominent nuclear dyserythropoiesis was observed in 17 patients, 14 with a frank type.
- Most cases with frank nuclear dyserythropoiesis showed low marrow parasitemia, inversely correlated with dyserythropoiesis severity.
Conclusions:
- Extended microscopy is recommended for detecting Leishman-Donovan bodies in suspected visceral leishmaniasis with prominent frank nuclear dyserythropoiesis.
- Frank nuclear dyserythropoiesis may be an indicator of low parasite burden.
- A common chemokine or cytokine might influence both nuclear dyserythropoiesis and marrow parasitemia.
Abstract:
Hematologists in the developing world are increasingly involved in diagnosing parasitic diseases that involve the bone marrow. With a worldwide annual incidence of half a million cases and 12 million infected people, visceral leishmaniasis is one such serious disease. It mainly affects malnourishedand economically underprivileged children. Recently, this disease has been seen in acquired immunodeficiency syndrome patients and in travelers to endemic areas. Over an 18-year period, 442 marrow examination requests were received by our department, and 105 cases of visceral leishmaniasis were diagnosed from findings of Leishman-Donovan bodies. Prominent nuclear dyserythropoiesis was shown in 17 patients, 14 of whom had the frank type that is uniquely seen in congenital dyserythropoietic anemia type II. Most of these cases showed an extremely low degree of marrow parasitemia. This degree of nuclear dyserythropoiesis was not found in the majority of the marrows in which parasites were more easily detected. There is a direct and negative correlationbetween frank nuclear dyserythropoiesis and marrow parasitemia. Extended microscopical examination is recommended for the detection of Leishman-Donovan bodies in cases of suspected visceral leishmaniasis when frank dyserythropoiesis is a prominent feature. It is possible that both frank nuclear dyserythropoiesis and marrow parasitemia are etiologically under the influence of a common chemokine or cytokine.
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