Visceral leishmaniasis: a trip to the Greek Islands is not always idyllic.

Although cutaneous leishmaniasis is occasionally seen in Australia in overseas travellers and migrants, visceral leishmaniasis has been reported rarely and only in people who were immunocompromised. We describe an 18-year-old immunocompetent man who presented with pancytopenia and a 2-week history of fever and lethargy a year after visiting the Greek Islands. Visceral leishmaniasis was diagnosed after a bone marrow biopsy showed protozoa, and the patient responded well to treatment with liposomal amphotericin. To our knowledge, this is the first case of visceral leishmaniasis in an immunocompetent patient in Australia.

Reasons for lower survival from non-Hodgkin's lymphoma among older patients.

Cancer-registry data for 710 patients, treated for non-Hodgkin's lymphoma (NHL) at a South Australian teaching hospital between 1977 and 2000, gave a five-year disease-specific survival of 53%, which was similar to population based estimates for Australia, the USA, and Europe. This figure reduced with age at diagnosis from 69% for patients less than 40 years at diagnosis to 30% for those aged 80 years or more. Multivariable analysis indicated that older age was predictive of lower survival (p<0.001), after adjusting for grade (Working Formulation), Ann Arbor stage,bulk disease, B symptoms (weight loss, unexplained fever, night sweats), extra-lymphatic site involvement, and diagnostic period. No other clinical variable, when included in the model, affected the risk coefficient for age. Even among patients gaining complete remission following chemotherapy, the relative risk of death from NHL was 2.11(95% CL: 1.24, 3.57) for patients aged 70 years or more at diagnosis when compared with younger patients. We conclude that older patients have lower survivals not explained by established risk factors and that this also applies to patients who achieve complete remission following chemotherapy.