Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection.

<h4>Background</h4>Visceral leishmaniasis (VL) could progress to secondary hemophagocytic lymphohistiocytosis (HLH), which is a rare but life-threatening condition with poor prognosis. So far, the clinical and laboratory characteristics of VL associated HLH have not been well elucidated....

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Autores principales: Qi Shi, Minjun Huang, Xiaoli Li, Xiaoyan Zheng, Fei Wang, Yang Zou, Lei Wang, Jidong Jia
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spelling oai:doaj.org-article:375fb98af2764ec0b654d71f89e885742021-12-02T20:23:59ZClinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection.1935-27271935-273510.1371/journal.pntd.0009944https://doaj.org/article/375fb98af2764ec0b654d71f89e885742021-11-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009944https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>Visceral leishmaniasis (VL) could progress to secondary hemophagocytic lymphohistiocytosis (HLH), which is a rare but life-threatening condition with poor prognosis. So far, the clinical and laboratory characteristics of VL associated HLH have not been well elucidated.<h4>Method and findings</h4>In this study, we retrospectively analyzed the clinical and laboratory profiles between 17 patients with VL associated HLH and 27 patients with VL alone admitted at the Beijing Friendship Hospital, Capital Medical University from May 2016 to March 2021. In addition to the identification of Leishmania infection, hemophagocytosis was identified in bone marrow in the most cases of VL associated HLH (15/17). The patients with VL associated HLH had higher chances of bleeding, hepatomegaly, thrombocytopenia, hypertriglyceridemia, hyperferritinemia, hypofibrinogenemia, elevated secretion of soluble IL-2 receptor or lower NK cell activity compared to patients with VL only. Furthermore, patients with VL associated HLH had higher inflammation status associated with higher levels of Th1 (TNF-α, IFN-γ, IL-1beta, IL-6, IL-8, IL-12p70), Th2 (IL-4) and Th17 cytokines (IL-17, IL-23) in the peripheral blood, and higher parasite load (qPCR and parasite culture). All 27 VL cases were totally recovered after being treated with Sodium Stibogluconate, five of the 17 patients with VL associated HLH died even after timely treatment with anti-parasite and immunosuppressive chemotherapy.<h4>Conclusion</h4>Without appropriate treatment, visceral leishmaniosis could develop to secondary HLH. The parasite culturing and qPCR detection of bone marrow samples facilitates the diagnosis of VL associated HLH in addition to other findings of HLH. Prompt treatment with anti-Leishmania and immunosuppressive chemotherapy is critical to reduce the mortality of VL associated HLH.Qi ShiMinjun HuangXiaoli LiXiaoyan ZhengFei WangYang ZouLei WangJidong JiaPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 11, p e0009944 (2021)
institution DOAJ
collection DOAJ
language EN
topic Arctic medicine. Tropical medicine
RC955-962
Public aspects of medicine
RA1-1270
spellingShingle Arctic medicine. Tropical medicine
RC955-962
Public aspects of medicine
RA1-1270
Qi Shi
Minjun Huang
Xiaoli Li
Xiaoyan Zheng
Fei Wang
Yang Zou
Lei Wang
Jidong Jia
Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection.
description <h4>Background</h4>Visceral leishmaniasis (VL) could progress to secondary hemophagocytic lymphohistiocytosis (HLH), which is a rare but life-threatening condition with poor prognosis. So far, the clinical and laboratory characteristics of VL associated HLH have not been well elucidated.<h4>Method and findings</h4>In this study, we retrospectively analyzed the clinical and laboratory profiles between 17 patients with VL associated HLH and 27 patients with VL alone admitted at the Beijing Friendship Hospital, Capital Medical University from May 2016 to March 2021. In addition to the identification of Leishmania infection, hemophagocytosis was identified in bone marrow in the most cases of VL associated HLH (15/17). The patients with VL associated HLH had higher chances of bleeding, hepatomegaly, thrombocytopenia, hypertriglyceridemia, hyperferritinemia, hypofibrinogenemia, elevated secretion of soluble IL-2 receptor or lower NK cell activity compared to patients with VL only. Furthermore, patients with VL associated HLH had higher inflammation status associated with higher levels of Th1 (TNF-α, IFN-γ, IL-1beta, IL-6, IL-8, IL-12p70), Th2 (IL-4) and Th17 cytokines (IL-17, IL-23) in the peripheral blood, and higher parasite load (qPCR and parasite culture). All 27 VL cases were totally recovered after being treated with Sodium Stibogluconate, five of the 17 patients with VL associated HLH died even after timely treatment with anti-parasite and immunosuppressive chemotherapy.<h4>Conclusion</h4>Without appropriate treatment, visceral leishmaniosis could develop to secondary HLH. The parasite culturing and qPCR detection of bone marrow samples facilitates the diagnosis of VL associated HLH in addition to other findings of HLH. Prompt treatment with anti-Leishmania and immunosuppressive chemotherapy is critical to reduce the mortality of VL associated HLH.
format article
author Qi Shi
Minjun Huang
Xiaoli Li
Xiaoyan Zheng
Fei Wang
Yang Zou
Lei Wang
Jidong Jia
author_facet Qi Shi
Minjun Huang
Xiaoli Li
Xiaoyan Zheng
Fei Wang
Yang Zou
Lei Wang
Jidong Jia
author_sort Qi Shi
title Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection.
title_short Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection.
title_full Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection.
title_fullStr Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection.
title_full_unstemmed Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection.
title_sort clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by leishmania infantum infection.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/375fb98af2764ec0b654d71f89e88574
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