Visceral leishmaniasis in leukemia patients, a great neglected disease in endemic countries: report of a retrospective study and systematic literature review.

BACKGROUND

Visceral leishmaniasis (VL) is an emerging infectious disease caused by the genus Leishmania and shares clinical features with some types of leukemia.

METHODS

In a retrospective study (2020-2022), bone marrow aspirates (BMAs) from 52 children with leukemia in Ardabil Province, northwestern Iran, were examined for the presence of VL via microscopy and specific polymerase chain reaction (PCR) methods. Additionally, the results of a systematic review of the literature on VL in these patients were reported.

RESULTS

In our retrospective study, microscopic investigations of BMA slides from 52 children with leukemia did not reveal Leishmania amastigotes. However, PCR detected amastigotes in three BMAs (5.8%). Simultaneously, a systematic review was designed, and 53 cases of VL with leukemia were retrieved. Half of these cases were from Brazil. Most cases were observed in children and adolescents (77.3%), with a higher prevalence in men (67.8%). The most common clinical and laboratory findings were: splenomegaly (96%), fever (90.5%), and anemia (92%). Acute lymphoblastic leukemia (ALL) was the most prevalent type of leukemia (66%). The systematic review on diagnostic accuracy showed that the serological method (sensitivity: 85%) proved to be more reliable than the microscopic method (sensitivity: 55%), while the PCR method detected all cases of leishmaniasis. Patients treated with anti-Leishmania drugs improved, except for one patient whose VL was reactivated one year later.

CONCLUSION

VL should be added to the list of possible differential diagnoses of leukemia patients, particularly in endemic areas, and physicians' awareness of this condition prevents unnecessary invasive diagnostic procedures.

CLINICAL TRIAL NUMBER: Not applicable.