The successful cultivation of a variety of haemoflagellates in three different liquid media is reported. These media include medium 199, Grace's insect tissue-culture medium and Schneider's drosophila medium, each in combination with 30% (v/v) foetal calf serum. These media were used to cultivate Old and New World species of visceral and cutaneous human Leishmania, as well as Leishmania species isolated from sandflies, rodents, and reptiles. Four strains of Trypanosoma cruzi, an isolate of T. R-angeli and and an isolate of T. lewisi have also been cultivated in these media. One or more of these media have been used to cultivate 121 strains of haemoflagellates, including at least 14 different species (11 Leishmania and 3 Trypanosoma) and many geographic isolates or strains. The Leishmania include L. braziliensis, L. peruviana, L. mexicana, L. tropica, L. donovani, L. chagasi, L. enriettii, L. hertigi, L. hoogstraali, L. adleri, and L. agamae. Using the Schneider's based medium, we have obtained primary isolates of both cutaneous and visceral Leishmania of man and of experimentally infected laboratory rodents and canines. Freeze-dried preparations of the Schneider's based medium that were reconsituted with distilled water after 24 months of storage at ambient temperature have proven to be suitable cultivation media. This feature makes the media valuable field tools. The various species of human Leishmania cultivated in these media have in our experience demonstrated no differences in growth rate, viability after liquid nitrogen preservation, or infectivity for laboratory animals and tissue-culture cells compared with promastigotes derived from blood-agar cultivation.

Haemoflagellates: commercially available liquid media for rapid cultivation

Hepatic rupture caused by peliosis hepatis.

The case is that of a 70-year-old Japanese male who had peliosis hepatis with disseminated peliotic lesions in various organs. The initial sign was spontaneous pneumothorax followed by pulmonary hemorrhage. There was no history of anabolic steroid ingestion and his history of pulmonary tuberculosis revealed no pathological changes. Autopsy findings suggested that dilatation of sinusoids with slow progressive injury of sinusoidal endothelium and hepatocytes due to unknown local and general etiologic factors may be an initial mechanism in the development of peliosis hepatis.

Peliosis hepatis. An unusual case involving multiple organs.

Two cases of peliosis hepatis, treated with a large dose of predonine for aplastic anemia and multiple myeloma, respectively, were reported. Case 1 showed no abnormal liver function, but, in Case 2 hepatomegaly, retention of ICG, and elevation of LDH level despite the normal serum transaminase were noted. In both cases, peliotic lesions were incidentally observed at autopsy. In Case 1, the lesion was localized in the right lobe only, but, in Case 2 the lesion was present throughout the entire lobes of the liver involving also a part of the spleen and bone marrow of the sternum. Innumerable blood-filled cavities were surrounded by incomplete reticulin or injured hepatocytes. In smaller lesions observed in Case 1, focal necrosis, hemorrhage, inflammation, and thrombi were prominent features. On the other hand, in extensive lesions, as in Case 2, a marked liver cell dissociation with sequent irregular reticulin arrangement was present. Though the etiology and peliosis hepatis is still uncertain in these cases, it was assumed that a large dose of predonine might have some correlation to the occurrence.

PELIOSIS HEPATIS Report of Two Autopsy Gases with a Review of Literature

Peliosis hepatis (PH) was first described by Wagner in 1861 (1), and in 1916 Schoenlank (2) introduced the term “peliosis,” which means livid or purpura from extravasated blood. This rare condition of unknown etiopathogenesis is characterized by blood-filled cavities caused by cystic dilation of the space of Disse or sinusoidal lumen. The cysts are distributed with no zonal predominance and may be lined with sinusoidal cells (3). Peliosis has been described in other parts of the reticuloendothelial system, including the lungs, spleen, and lymph nodes (4–7). In adults, PH usually is associated with chronic pathologic conditions, including tuberculosis, cystic fibrosis, and human immunodeficiency virus (HIV) infection (8–10). More recently, a pathogenic link with Bartonella henselae was suggested (9,11). PH also has been reported after the use of anabolic steroids, azathioprine (12), 6-thioguanine and 6-mercaptopurine (12), and oral contraceptives (14). In children, PH has been reported mostly with underlying chronic conditions, such as cystic fibrosis (15), malnutrition (16), Fanconi anemia (17), adrenal tumors (18), Marfan syndrome (19), congenital cardiopathy (20), myotubular myopathy (21), or after renal transplantation (12). PH in children without underlying pathologic conditions is rare, only three cases having been reported in the literature. In two cases, the hypothesis of a bacterial infection (eg, Escherichia coli) and subsequent endotoxin release, causing the acute formation of the peliotic lesions, was suggested (22). We report a child who experienced hemoperitoneum and reversible multiorgan failure secondary to PH.

Peliosis hepatis in childhood: case report and review of the literature.

Peliosis hepatis in an infant.

Visceral leishmaniasis was found in three Honduran patients, and in a fourth this diagnosis was suspected because of the clinical presentation and for epidemiological reasons. All four cases originated from the same general area of Honduras. Three patients lived in the same valley approximately 35 km northeast of Tegucigalpa, and were related. Two patients died without the diagnosis having been made; two are responding to specific therapy.

Visceral leishmaniasis in Honduras. Report of three proven cases and a suspected case.

ment on the marrow space and the subsequently disturbed marrow microenvironment , and settling in extramedullary sites, notably the liver and spleen, which become major sites of hematopoiesis This would also explain the presence of immature cells (myelocytes and nucleated red cells) in the peripheral blood of these infants Our findings are similar to those of Chervenick 3 who demonstrated that adult patients with myelofibrosis had four to 40 times the normal number of CFC in their peripheral blood compared to normal individuals We have also noted a similar increase in the peripheral blood CFC in Children with acute lymphocytic leukemia? It would appear that whenever the bone marrow microenvironment is perturbed by an exogenous tissue (fibrous, osteoid, or leukemic), the progenitor cells migrate to extramedullary sites Our studies would also suggest that the serum of these patients may contain factor(s) which stimulate in vitro granulopoiesis

Steven P. Nuernberger

Papers

Peliosis hepatis in an infant.

Visceral leishmaniasis in Honduras. Report of three proven cases and a suspected case.

Peliosis infant* hepatis in an