ABSTRACT

A 16 month-old boy was referred to our hospital with a prolonged fever, hepatosplenomegaly, anemia and leucopenia. Visceral leishmaniasis was the first suspected diagnosis but the bone-marrow aspiration material revealed no Leishmania amastigotes. As the group agglutination test for Salmonella typhi-O was positive at 1/320 dilution, a diagnosis of salmonellosis was made and meropenem therapy was started. Although the fever decreased on the fourth day of therapy, the expected clinical improvement did not occur and there was a recurrence of the fever. At that point even though his parents were told about the seriousness of his condition, they had the patient charged from the hospital. About one week later, the patient was hospitalized again with the same complaints. His organomegaly had increased and his pancytopenia was more severe at this time. The re-assessment of the patient raised again the suspicion of kala azar. IFAT for Leishmania infection demonstrated a high level of positivity (1/1024) and a second bone-marrow aspiration material revealed Leishmania amastigotes. After the patient was started on meglumine antimonate therapy, his clinical and laboratory findings improved. The case has been evaluated according to two different points of view based on the co-existence of salmonellosis and kala azar or a possible false positive Widal reaction in kala-azar.

Keywords: Salmonellosis, kala azar, co-infection, Widal reaction