PMC9469688_01
Abdominal ultrasound image of the 47-year-old at 2020.12.04. (A) Intercostal spleen thickness was ~7.0 cm and parenchymal echo was uniform; (B) Hepatomegaly with liver parenchymal damage; (C) Liver hardness measurement: 12.3 kpa.
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F1
Autoimmune liver, alpha fetoprotein (AFP), and carcinoembryonic antigen were negative. Abdominal ultrasound showed enlarged liver and spleen (Figure 1).
The metagenomic next-generation sequencing (mNGS) of blood sample of 47-year-old kala-azar patient. (A) mNGS result showed 118,783 microorganism sequence reads and 14,812 Leishmania Infantum reads, which accounted for 1.91% (626118/32803598) of the whole genome. (B) mNGS of blood sample showed a total of 118,783 microorganism sequence reads, and 17,299 reads of Leishmania Donovani, accounting for 2.14% (726792/34012130) of the whole genome.
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F2
The blood mNGS test results on the 4th day of admission detected Leishmania infantum and Leishmania donovani (Figure 2).
PMC9469688_02
Abdominal color ultrasound of 15-year-old patient. (A) Examination results on the first day of admission showed that the intercostal spleen thickness was approximately 6.6 cm and parenchymal echo was uniform, indicating splenomegaly. (B) On the 14th day of admission, the spleen was retracted, and the thickness of the spleen was about 5.1 cm. (C) Follow-up 1 month after discharge, the spleen was retracted, and the thickness was about 4.5 cm.
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F3
Abdominal ultrasound showed that the spleen thickness was ~6.6 cm intercostal, suggesting splenomegaly (Figure 3A). On the 14th day of admission, the spleen was retracted, and the thickness of the spleen was about 5.1 cm (Figure 3B). The intercostal spleen thickness was ~4.5 cm (Figure 3C).
The mNGS of the blood sample of 15-year-old patient. Result showed 139,030 microorganism sequence reads and 20,629 Leishmania Infantum reads, which accounted for 2.65% (869709/32803598) of the whole genome.
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F4
On the fourth day, the mNGS test results of the patient showed Leishmania infantum (Figure 4).