Leishmaniasis and pregnancy – a case report and review of literature

Medical Review (Med. pregled), 2023, 59(3), 39-44.

M. Atanasova

Department of Obstetrics and Gynecology, Acibadem City Clinic UMHAT Tokuda Hospital – Sofia

Abstract. A case of visceral leishmaniasis, diagnosed in the second trimester of pregnancy is described. The disease is rare of our country, so that there are difficulties in diagnosis and differential diagnosis. The treatment of disease was difficult because of the pregnancy. Review of contemporary literature is made with analysis of the therapeutic approaches in cases of visceral leishmaniasis during pregnancy. The impact of protozoal disease on labor and delivery, the fetus and the newborn and the route of delivery are discussed. Introduction: Leishmaniasis is a disease caused by an intracellular protozoan parasite (genus Leishmania) transmitted by the bite of a sandfly. The clinical spectrum of leishmaniasis ranges from a self-resolving cutaneous ulcer to a mutilating mucocutaneous disease and even to a lethal systemic illness. Therapy has long been a challenge in the more severe forms of the disease, and it is more difficult by the emergence of drug resistance. Infection with Leishmania chagasi during pregnancy is rare and deserves special attention since little information is available regarding the occurrence of visceral leishmaniasis during gestational period and the real possibility of vertical transmission of this disease. In our case leishmaniosis was diagnosed in 28 weeks of gestation, by direct microscopy of bone marrow sampling. Free extracellular Leishmanias were seen. Glucantime was used for etiologic therapy, but Amphotericin B is strongly recommended as the first choice drug due to its fewer maternal-fetal adverse effects. Labor was induced in 41 wg, due to the postterm pregnancy and favorable pelvic score. There was no vertical transmission of leishmaniasis. Currently, the born baby is eight years old with normal physical and mental development.

Key words: Leishmania, leishmaniosis, pregnancy, therapy, Amphotericin B

Address for correspondence: Maria Atanasova MD, e-mаil: mgicheva@abv.bg