关键词: 内脏利什曼病, 高通量测序, 丙型病毒性肝炎肝硬化, 骨髓穿刺

Abstract:

The individual was a 74-year-old farmer from Pingding district of Yangquan City, Shanxi Province. In January 2023, he went to the local hospital due to cough, expectoration and general fatigue. He was diagnosed with mycoplasma, SARS-Cov-19 and other pulmonary infections with mild anemia. The condition temporarily improved after receiving ongoing oxygen therapy and antimicrobial treatment. The patient continued to experience repeated systemic fatigue and was treated in multiple hospitals for over 6 months. On July 10th, he went to the Department of Infectious Diseases at the First Hospital of Shanxi Medical University for treatment. Admission examination: The patient had intermittent low fever, anemic appearance, skin pigmentation from scratching, ascites, soft abdomen and distended, hepatomegaly, splenomegaly, mild lower limb edema. Blood tests showed a leucocyte count of 2.4 × 10⁹/L, hemoglobin 62.0 g/L, red blood cell count of 2.09 × 10¹²/L, platelet count of 94 × 10⁹/L, and hepatitis C virus antibody positive, abdominal CT noted cirrhosis, hepatomegaly, splenomegaly, while abdominal ultrasound revealed ascites, and liver transient elastography was 24.7, the initial diagnosis was hepatitis C virus cirrhosis. Bone marrow puncture and smear analysis revealed toxic granules in neutrophil cytoplasm and the absence of Leishmania. During a reexamination on July 17th, ELISA returned negative for hepatitis C virus antigen and antibody, and fluorescence quantitative PCR detected hepatitis C virus nucleic acid concentration below 1.0 × 10³ IU/ml, implying misdiagnosis initially. The patient had a history of multiple blood transfusions for anemia and had multiple contact histories with street dogs. The history of sandfly bites was unclear. The rK39 immunochromatography strip result and subsequent high-throughput nucleotide sequencing of pathogenic microorganisms identified 4 101 Leishmania DNA sequences, including 95 Leishmania infantum DNA sequences, confirming leishmaniasis. Following treatment with sodium stibogluconate injection (6 ml/d, 10 d), the temperature remained normal, liver and spleen sizes significantly decreased, and skin lesions improved after 15 days of therapy, involving liver protection, protein and red blood cell transfusion, fluid replacement, and diuresis.

Key words: Visceral leishmaniasis, High throughput nucleotide sequencing, Hepatitis C liver cirrhosis, Bone marrow puncture