Visceral leishmaniasis: bone marrow biopsy findings

Area of Science:

• Medical Parasitology
• Pediatric Infectious Diseases
• Hematology

Background:

• Visceral leishmaniasis (VL), also known as Kala-azar, is a significant parasitic infection affecting children in Iran.
• Understanding prognostic indicators is crucial for managing VL effectively in pediatric populations.

Purpose of the Study:

• To retrospectively analyze bone marrow biopsy findings in pediatric VL cases.
• To assess the correlation between specific bone marrow histopathological patterns and patient prognosis and treatment response.

Main Methods:

• Retrospective evaluation of medical records for 249 children diagnosed with VL.
• Detailed analysis of clinical, hematologic, and bone marrow biopsy findings.
• Categorization of bone marrow findings into five distinct groups based on cellularity, presence of Leishman Donovan (LD) bodies, granulomas, fibrosis, lymphoid nodules, and necrosis.

Main Results:

• Five distinct bone marrow biopsy patterns were identified, correlating with prognosis.
• Hypercellular marrow with LD bodies and benign lymphoid nodules with LD bodies showed excellent outcomes and good response to glucantime.
• Diffuse fibrosis with rare LD bodies and marrow necrosis with LD bodies were associated with poor prognosis and resistance to therapy.
• Granulomas with few LD bodies showed intermediate outcomes, responding to amphotericin B but not glucantime.

Conclusions:

• Bone marrow biopsy findings are valuable for predicting the prognosis of pediatric visceral leishmaniasis.
• Histopathological patterns can guide treatment strategies and patient management, differentiating between responsive and resistant cases.