Висцеральный лейшманиоз: трудный дифференциальный диагноз в терапевтической практике
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Brovko M.Iu., Akulkina L.A., Potapov P.P., et al. Visceral leishmaniasis: a challenging diagnosis in internal medicine. Therapeutic Archive. 2020; 92 (11): 117–121. DOI: 10.26442/00403660.2020.11.000619
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В Российской Федерации большинство зафиксированных случаев связано с посещением стран, эндемичных по лейшманиозу; в то же время имеются единичные сообщения о развитии заболевания у лиц, посетивших южные регионы России (Крым, Дагестан) и Закавказье или постоянно проживающих в них. Отсутствие настороженности со стороны клиницистов существенно затрудняет своевременную постановку правильного диагноза и может привести к выбору неверной тактики лечения. В статье рассмотрены современные представления об эпидемиологии, подходах к диагностике и лечению лейшманиоза; обсуждаются особенности представленного клинического случая.
Ключевые слова: лейшманиоз, аутоиммунный гепатит, лимфома, лихорадка неясного генеза.
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Leishmaniasis is a vector-born parasitic disease characterized by predominant cutaneous or visceral involvement with fever, hepatosplenomegaly and anemia. Leishmaniasis has relatively high prevalence in tropical and subtropical areas. Several sporadic and mostly imported cases are detected in Russian Federation. Nevertheless, some local incidents are noted in southern areas (Crimea, Dagestan). Lack of epidemiological alertness hampers confirmation of diagnosis and may lead to incorrect treatment. The article summarizes current state of knowledge in epidemiology, diagnostic approach and treatment of leishmaniasis. Particular clinical case is discussed.
Keywords: leishmaniasis, autoimmune hepatitis, lymphoma, fever of unknown origin.
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3. WHO. Epidemiological situation. WHO – 2018.
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5. Aronson N, Herwaldt BL, Libman M, et al. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Am J Trop Med Hyg. 2017;96(1):24-5. doi: 10.4269/ajtmh.16-84256
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8. Boelaert M, Verdonck K, Menten J. Rapid tests for the diagnosis of visceral leishmaniasis in patients with suspected disease. Cochrane Database Syst Rev. 2014. doi: 10.1002/14651858.CD009135.pub2
9. Hickey AJ, Gounder L, Moosa M-YS, et al. A systematic review of hepatic tuberculosis with considerations in human immunodeficiency virus co-infection. BMC Infect Dis. 2015;15:209. doi: 10.1186/s12879-015-0944-6
10. Dean AS, Crump L, Greter H, et al. Clinical Manifestations of Human Brucellosis: A Systematic Review and Meta-Analysis. PLoS Negl Trop Dis. 2012;6(12):e1929с. doi: 10.1371/journal.pntd.0001929
11. Shaker Y, Samy N, Ashour E. Hepatobiliary Schistosomiasis. J Clin Transl Hepatol. 2014;2(3):212-6. doi: 10.14218/JCTH.2014.00018
12. Kawakami A, Fukunaga T, Usui M. Visceral leishmaniasis misdiagnosed as malignant lymphoma. Intern Med. 1996;35(6):502-6. doi: 10.2169/internalmedicine.35.502
13. Yabe M, Miranda RN, Medeiros LJ. Hepatosplenic T-cell Lymphoma: a review of clinicopathologic features, pathogenesis, and prognostic factors. Hum Pathol. 2018;74(5):16. doi: 10.1016/j.humpath.2018.01.005
14. Lunning MA, Vose JM. Angioimmunoblastic T-cell lymphoma: the many-faced lymphoma. Blood. 2017;129(9):1095-102. doi: 10.1182/blood-2016-09-692541
15. Lamy T, Moignet A, Loughran TP. LGL leukemia: from pathogenesis to treatment. Blood. 2017;129(9):1082-94. doi: 10.1182/blood-2016-08-692590
16. Owlia MB, Newman K, Akhtari M. Felty’s Syndrome, Insights and Updates. Open Rheumatol J. 2014;8(129):36. doi: 10.2174/1874312901408010129
17. Liberopoulos E, Kei A, Apostolou F, et al. Autoimmune manifestations in patients with visceral leishmaniasis. J Microbiol Immunol Infect. 2013;46(4):302-5. doi: 10.1016/j.jmii.2012.01.016
18. Santana IU, Dias B, Nunes EAS. Visceral leishmaniasis mimicking systemic lupus erythematosus: Case series and a systematic literature review. Semin. Arthritis Rheum. 2015;44(6):658-65. doi: 10.1016/j.semarthrit.2014.12.004
1 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2 ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова», Москва, Россия;
3 ФБУН «Центральный научно-исследовательский институт эпидемиологии» Роспотребнадзора, Москва, Россия
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M.Iu. Brovko1, L.A. Akulkina1, P.P. Potapov2, V.I. Sholomova1, M.V. Lebedeva1, T.P. Nekrasova1, V.A. Varshavskii1, E.V. Volchkova1, T.P. Rozina1,2, E.N. Nikulkina1, L.S. Karan3, S.V. Moiseev1,2, V.V. Fomin1
1 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2 Lomonosov Moscow State University, Moscow, Russia;
3 Central Research Institute of Epidemiology, Moscow, Russia