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Case Report: The First Case Report of Visceral Leishmaniasis in Cambodia

Sam LyvannakAngkor Hospital for Children, Siem Reap, Cambodia;

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Korb SreynichAngkor Hospital for Children, Siem Reap, Cambodia;

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Sing HengAngkor Hospital for Children, Siem Reap, Cambodia;

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Miliya ThylAngkor Hospital for Children, Siem Reap, Cambodia;

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Arjun ChandnaAngkor Hospital for Children, Siem Reap, Cambodia;
Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom;

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Ngoun ChanpheaktraAngkor Hospital for Children, Siem Reap, Cambodia;

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Ngeth PisesAngkor Hospital for Children, Siem Reap, Cambodia;

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Prak FarrilendAngkor Hospital for Children, Siem Reap, Cambodia;

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Jason JarzembowskiMedical College of Wisconsin, Milwaukee, Wisconsin;

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Vasiliki LeventakiMedical College of Wisconsin, Milwaukee, Wisconsin;

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Jonathan DavickUniversity of Iowa, Iowa City, Iowa;

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Cindy NeunertColumbia University, New York City, New York;

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Frank KellerAflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia;

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Leslie S. KeanBoston Children’s Hospital, Dana Farber Cancer Institute, Boston, Massachusetts;

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Bruce CamittaMedical College of Wisconsin, Milwaukee, Wisconsin;

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Katherine TarlockSeattle Children’s Hospital, Seattle, Washington

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Benjamin WatkinsAflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia;

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ABSTRACT.

Leishmaniasis is considered a neglected tropical disease that is commonly found in Asia, Africa, South America, and Mediterranean countries. Visceral leishmaniasis (VL) is the most severe form of the disease and is almost universally fatal if left untreated. The symptoms of VL overlap with many infectious diseases, malignancies, and other blood disorders. The most common findings include fever, cytopenias, and splenomegaly. Given the nonspecific symptoms, the diagnosis requires detailed laboratory investigations, including bone marrow examination, that can be challenging in low- and middle-income countries. Diagnostic limitations likely lead to the underdiagnosis or delay in diagnosis of VL. We describe, to our knowledge, the first case report of VL in Cambodia in a child presenting with fever, anemia, and thrombocytopenia. The diagnosis required a liver biopsy and multiple bone marrow biopsies to visualize intracellular Leishmania spp. Our case illustrates the diagnostic challenges and the importance of timely diagnosis. This case also highlights the need for heightened awareness of the diagnostic findings of VL and improved reporting of tropical diseases.

Author Notes

Address correspondence to Benjamin Watkins, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, 2015 Uppergate Dr., Atlanta, GA 30322. E-mail: benjamin.watkins@emory.edu

Disclosure: This study was approved by the institutional review board, and the patient’s family provided written consent for the review of their medical records and publication of the results, per the Declaration of Helsinki.

Author contributions: S. L., K. S., B. C., K. T., and B. W. wrote the paper. J. J., V. L., and J. D. analyzed data. S. L., K. S., S. H., A. C., M. T., N. C., N. P., and P. F. collected the data. C. N., F. K., L. K., B. C., K. T., and B. W. supervised the research and edited the manuscript.

Authors’ addresses: Sam Lyvannak, Korb Sreynich, Sing Heng, Miliya Thyl, Ngoun Chanpheaktra, Ngeth Pises, and Prak Farrilend, Angkor Hospital for Children, Siem Reap, Cambodia, E-mails: vannak_samly@yahoo.com, korbsreynich@gmail.com, singheng@angkorhospital.org, miliya_thyl@angkorhospital.org, pheaktra@angkorhospital.org, npises@angkorhospital.org, and prakfarrilend@gmail.com. Arjun Chandna, Angkor Hospital for Children, Siem Reap, Cambodia, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom, E-mail: arjun@tropmedres.ac. Jason Jarzembowski, Vasiliki Leventaki, and Bruce Camitta, Medical College of Wisconsin, Milwaukee, WI, E-mails: jjarzemb@mcw.edu, vleventaki@mcw.edu, and bcamitta@mcw.edu. Jonathan Davick, University of Iowa, Iowa City, IA, E-mail: jonathan-davick@uiowa.edu. Cindy Neunert, Columbia University, New York City, NY, E-mail: cn2401@cumc.columbia.edu. Frank Keller and Benjamin Watkins, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, GA, and Emory University, Atlanta, GA, E-mails: frank.keller@choa.org and benjamin.watkins@emory.edu. Leslie S. Kean, Boston Children’s Hospital, Dana Farber Cancer Institute, Boston, MA, E-mail: leslie_kean@dfci.harvard.edu. Katherine Tarlock, Seattle Children’s Hospital, Seattle, WA, E-mail: katherine.tarlock@seattlechildrens.org.

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