OUR EXPERIENCE OF KALA-AZAR DIAGNOSIS IN CHILD PATIENTS

Visceral leichmaniasis/kala-azar is a parasitic disease, in a group of vector-borne infections. Phlebotomies represent the primary vectors of the aetiological agent Leichmania donovani. In our environment, the endemic area for kala-azar is the southern part of the Montenegrin coast. In the clinic for infectious disease in Podgorica, in the period 2005–7, we examined five child patients with a clinical diagnosis of kala-azar. In all patients the diagnosis had been aetiologically confirmed, on the basis of biopsy analysis of marrow: direct microscopy of serial cut, coloured by Giemsa-i, reticulin/Gordon Sweet, PAS methods and immune-biochemical methods/TdT, CD34, CD117, CD15, glycophorin A, CD31, CD79a, CD20, CD3, CD45RO, CD38, kappa, lambda, IgG, IgM, IgA, CD68. With the agglutination test we serologically confirmed a diagnosis of disease in two cases. All five patients had common or temporary stay in the endemic area of kala-azar. In the clinic specter of disease, the spleen and liver megalithic and dysfunction and anaemia were found in all five patients, weakness in three, increasing leucocytes in two, high sedimentation in three cases. In direct microscopy of marrow biopsy material shapes of parasites were found in all cases. Clinical manifestations of kala-azar depend on the issue of complex interaction between parasite and immunological defence of the host. Every infection does not lead to clinically manifest disease; however, hypothesis about long-lasting persistent ion of living parasitic agent L donovani after infection, putting her in mean foul opportunistic agents, which is also confirmed with fact of reassign number of immunity-compromised patients with visceral leichmaniasis.