Case 50.  Leishmania donovani infection (Kala azar) (54 y-o M)
         
    Liver biopsy from a Japanese worker who stayed in India, showing prolonged fever and liver dysfunction    
         
   
Key words :  Kala azar, Leishmania donovani, microgranuloma
   
         
   
zoonosis
   
     
 
     
Microgranulomas are formed in the liver parenchyma. Diffuse activation of Kupffer cells is associated (HE).   The microgranulomas consist of activated Kupffer cells. No pathogens are discernible histologically (HE, high power).
     
 
     
The 1:500 diluted patien's own serum detects granular (round-shaped) pathogens in the cytoplasm of macrophages in the microgranulomas, strongly suggesting visceral leishmaniasis (indirect immunoperoxidase). The diagnosis was confirmed serologically.   Reference case 50A
Autopsied liver of visceral leishmaniasis in a Kenyan adult (HE). In this case, diffuse activation of Kupffer cells is noted, but no microgranulomatous nodule formation (HE).
     
 
     
Reference case 50A
Autopsied liver of visceral leishmaniasis in a Kenyan adult (HE, oil immersion). Oil immersion observation discloses the occurrence of haloed small granules (protozoan bodies) in the cytoplasm of Kupffer cells (HE).
  Reference case 50B
Stamp smear of the spleen of a Chinese boy infected with L. infantum (Giemsa). Numerous protozoan bodies are phagocytized by macrophages. L. infantum provoking systemic visceral involvement is endemic in the inland part of China.