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| Year : 2015 | Volume
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| Issue : 2 | Page : 262-263 |
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| Leishmania donovani bodies in neutrophils on a peripheral blood smear examination: Report of an unusual incident in a clinically unsuspected case |
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Surabhi, Khaliqur Rahman, Manish K Singh, Ruchi Gupta
Department of Hematology, SGPGI, Lucknow, Uttar Pradesh, India
Click here for correspondence address and email
| Date of Web Publication | 17-Apr-2015 |
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How to cite this article:
Surabhi, Rahman K, Singh MK, Gupta R. Leishmania donovani bodies in neutrophils on a peripheral blood smear examination: Report of an unusual incident in a clinically unsuspected case. Indian J Pathol Microbiol 2015;58:262-3 |
How to cite this URL:
Surabhi, Rahman K, Singh MK, Gupta R. Leishmania donovani bodies in neutrophils on a peripheral blood smear examination: Report of an unusual incident in a clinically unsuspected case. Indian J Pathol Microbiol [serial online] 2015 [cited 2023 Sep 30];58:262-3. Available from: https://www.ijpmonline.org/text.asp?2015/58/2/262/155356 |
Editor,
Leishmaniasis is a spectrum of diseases caused by Leishmania species, affecting approximately 12 million people worldwide, mostly in the developing countries. They replicate as intracellular, aflagellated amastigotes in the phagocytic cells such as neutrophils, macrophages, and dendritic cells. [1] We present here a case of clinically unsuspected case of Kalaazar where peripheral blood and bone marrow showed Leishmania donovani (LD) bodies in the neutrophils.
A 70-year-old male, resident of Varanasi who presented to the Department of Urology with complains of gross painless hematuria and passing of clots since 6 months. Physical examination showed pallor. No lymphadenopathy or organomegaly was present.
Routine investigations showed a normal liver and renal profile. Complete blood count showed hemoglobin, total leucocyte count and platelets of 80 g/L, 3.6 × 10 9 /L and 53 × 10 9 /L respectively. Cystourethroscopy showed a bladder mass diagnosed as high grade muscle invasive urothelial carcinoma on biopsy. In view of pancytopenia, his peripheral blood smear morphology and subsequent bone marrow procedure (to rule out metastasis) was planned.
The peripheral blood smear findings showed microcytic hypochromic red blood cells. To our surprise, we found approximately 8% polymorphs and occasional monocytes containing LD bodies in the smear. Few polymorphs contained even 3-4 LD bodies. Platelets were also reduced on smear. A subsequent bone marrow examination also revealed the presence of extracellular and intracellular (macrophages and polymorphs) amastigote forms [Figure 1]. There was no focus of metastasis in bone marrow biopsy. Antibody for rk39 antigen was later found positive in this patient. | Figure 1: Bone marrow aspiration smear showing presence of two Leishmania donovani (LD) bodies inside a neutrophils. The Inset shows presence of 4 LD bodies inside a neutrophil in the peripheral blood, (May Grunwald Giemsa, oil immersion)
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Following entry of Leishmania parasite into the mammalian host, polymorphs are the first effector cells recruited to the site of infection, implying that they possibly serve as host cells for Leishmania parasites in the very early phase of infection. Leishmania parasites then enter into macrophages via the uptake of infected, apoptotic polymorphonuclear neutrophils, thereby being present in the bone marrow and splenic aspirates. [2] It is, therefore, possible that the patient was in the early phase of the disease to show peripheral blood neutrophils laden with LD bodies, but his pancytopenia could not be explained by this fact.
Finding LD bodies in the monocytes, and occasionally neutrophils of peripheral blood using a buffy coat preparation has already been documented. [3] However in our case, we found numerous polymorphs laden with multiple (1-4) LD bodies and this finding lays the importance of vigilant peripheral blood smear examination useful in preventing the use of advanced and costly diagnostic modalities in the diagnosis of visceral leishmaniasis along with unnecessary workup.
 References | |  |
| 1. | Singh OP, Sundar S. Immunotherapy and targeted therapies in treatment of visceral leishmaniasis: Current status and future prospects. Front Immunol 2014;5:296.  |
| 2. | Laskay T, van Zandbergen G, Solbach W. Neutrophil granulocytes as host cells and transport vehicles for intracellular pathogens: Apoptosis as infection-promoting factor. Immunobiology 2008;213:183-91. |
| 3. | Varma N, Naseem S. Hematologic changes in visceral leishmaniasis/kala azar. Indian J Hematol Blood Transfus 2010;26:78-82. |
Correspondence Address:
Dr. Khaliqur Rahman
Department of Hematology, SGPGI, Raebareily Road, Lucknow - 226 014, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0377-4929.155356
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