Leishmania donovani visceral leishmaniasis diagnosed by metagenomics next-generation sequencing in an infant with acute lymphoblastic leukemia: a case report

Abstract

Background: Visceral leishmaniasis (VL) is a neglected vector-borne tropical disease caused by Leishmania donovani (L. donovani) and Leishmania infantum (L. infantum). Due to the very small dimensions of the protozoa impounded within blood cells and reticuloendothelial structure, diagnosing VL remains challenging.

Case presentation: Herein, we reported a case of VL in a 17-month-old boy with acute lymphoblastic leukemia (ALL). The patient was admitted to West China Second University Hospital, Sichuan University, due to repeated fever after chemotherapy. After admission, chemotherapy-related bone marrow suppression and infection were suspected based on clinical symptoms and laboratory test results. However, there was no growth in the conventional peripheral blood culture, and the patient was unresponsive to routine antibiotics. Metagenomics next-generation sequencing (mNGS) of peripheral blood identified 196123 L. donovani reads, followed by Leishmania spp amastigotes using cytomorphology examination of the bone marrow specimen. The patient was given pentavalent antimonials as parasite-resistant therapy for 10 days. After the initial treatment, 356 L. donovani reads were still found in peripheral blood by mNGS. Subsequently, the anti-leishmanial drug amphotericin B was administrated as rescue therapy, and the patient was discharged after a clinical cure.

Conclusion: Our results indicated that leishmaniasis still exists in China. Unbiased mNGS provided a clinically actionable diagnosis of a specific infectious disease from an uncommon pathogen that eluded conventional testing.

Keywords: Leishmania donovani; acute lymphoblastic leukemia; case report; metagenomic next-generation sequencing; rapid diagnosis; visceral leishmaniasis.

Figure 1

The diagnosis of Leishmania infection by metagenomics next-generation sequencing (mNGS). (A) Mapping of Leishmania donovani reads on the genome. (B) Distribution of pathogenic microorganisms reads in the absence of human, others, and unclassified reads.

Figure 2

Bone marrow cytology of this patient. Arrowheads show the Leishmania spp amastigotes in extracellular and phagocyte, which are oval and 2.9–5.7 × 1.8–4.0 μm in size (Wright's stain, × 1,000).

Figure 3

The follow-up diagnosis of Leishmania infection after using pentavalent antimonials 10 days by mNGS. (A) Mapping of Leishmania donovani reads on the genome. (B) Distribution of pathogenic microorganisms reads in the absence of human, others, and unclassified reads.