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      Visceral leishmaniasis with pleural effusion in an immunocompetent patient

      case-report

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          Abstract

          Visceral leishmaniasis (VL) is usually characterized by splenomegaly, pallor and fever. Pleural effusion is an uncommon feature of this disease, which is encountered in immunocompromised patients. Here, we report a case of VL with pleural effusion in an immunocompetent patient. Pulmonary symptoms in VL are usually related to bacterial lung infection, vagal nerve compression by splenomegaly, and hypoalbuminaemia with mild pulmonary edema. Our patient presented with cough and chest pain. The clinical features of this case were baffling since they mimicked that of pulmonary tuberculosis. This case report emphasizes the need to recognize the diverse nature of presentation of this curable yet fatal infectious disease.

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          Most cited references15

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          Leishmaniasis.

          Epidemiology, disease patterns, immunology, diagnosis, treatment and control measures of leishmaniasis are described. Various issues relating to leishmaniasis are highlighted: the relative lack of importance given to this disease is compared with other infections, climate change and its possible effect on extension of endemicity of this infection, and new diagnostic tests that are helping better diagnosis, especially in resource-poor areas. Other important aspects discussed include the potential for newer oral treatment to change the way this disease is managed; leishmania-HIV coinfection and groups at risk; and the development of an effective vaccine.
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            Visceral leishmaniasis during childhood in southern Greece.

            Records were reviewed of 82 immunocompetent children (median age, 2. 5 years) from southern Greece who were diagnosed with visceral leishmaniasis from 1986 through 1998. Forty-nine (58%) patients originated from the city of Athens; of them, 46 (94%) lived by hills bordering the city. The median interval from the onset of symptoms to admission was 10 days. Fever and splenomegaly were observed in >95% of the patients. Thrombocytopenia was the most frequent hematological finding (80%). All patients were treated with meglumine antimonate; 20 (24%) of them were partially treated on an outpatient basis. Rapid clinical response was noted in all patients but one. Five patients relapsed; 3 responded to reintroduction of meglumine antimonate, 1 responded to liposomal amphotericin B, and 1 underwent splenic artery ligation. We conclude that pentavalent antimonials remain the first choice of treatment for visceral leishmaniasis in immunocompetent children in areas where resistance has not become a problem. It is possible to treat affected patients with outpatient administration of these agents, making them feasible options for therapy.
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              Acquired immunodeficiency syndrome-related visceral leishmaniasis presenting in a pleural effusion.

              Visceral leishmaniasis is increasingly reported in immunocompromised patients, including patients with AIDS. We report a case of visceral leishmaniasis in an AIDS patient who presented with pulmonary symptoms and bilateral pleural effusions. Histologic evaluation of pleural fluid and bone marrow revealed histiocytes with intracellular Leishmania amastigotes. Visceral leishmaniasis should be considered in AIDS patients with a significant travel history who present with unexplained pulmonary symptoms.
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                Author and article information

                Journal
                Lung India
                Lung India
                LI
                Lung India : Official Organ of Indian Chest Society
                Medknow Publications & Media Pvt Ltd (India )
                0970-2113
                0974-598X
                Jan-Mar 2014
                : 31
                : 1
                : 56-58
                Affiliations
                [1] Department of Pathology, Medical College, College Street, Kolkata, West Bengal, India
                [2] Department of Pathology, ESI PGIMSR, Manicktala, Kolkata, West Bengal, India
                Author notes
                Address for correspondence: Dr. Senjuti Dasgupta, Department of Pathology, Medical College, Kolkata, West Bengal, India. E-mail: dasguptasenjuti@ 123456gmail.com
                Article
                LI-31-56
                10.4103/0970-2113.125913
                3960813
                24669085
                f57315fb-3fea-44c2-b81c-71ae6799f401
                Copyright: © Lung India

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                Respiratory medicine
                immunocompetent patient,pleural effusion,visceral leishmaniasis
                Respiratory medicine
                immunocompetent patient, pleural effusion, visceral leishmaniasis

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