Epidemiological and clinical features of visceral leishmaniasis in children in Alicante Province, Spain. (3rd July 2018)

• Record Type: Journal Article
• Authors: Ramos, Jose M.; Clavijo, Agustin; Moral, Luis; Gavilan, Cesar; Salvador, Tatiana; González de Dios, Javier
• Is Part Of: Paediatrics and international child health. Volume 38:Number 3(2018)
• Page Start: 203
• Page End: 208
• Publication Date: 2018-07-03
• Subjects: Visceral leishmaniasis -- paediatrics -- child -- epidemiology -- signs and symptoms -- liposomal amphotericin B -- Spain; Pediatrics -- Developing countries -- Periodicals; Children -- Health and hygiene -- Developing countries -- Periodicals; Children -- Diseases -- Developing countries -- Periodicals; 618.920009172405
• DOI: 10.1080/20469047.2018.1468585
• Languages: English
• ISSNs: 2046-9047

Abstract

Abstract: Background: Visceral leishmaniasis (VL) is endemic to the Mediterranean basin. In children, VL often presents with non-specific symptoms and can be life-threatening without proper treatment. Aim: To describe the epidemiological and clinical features of pediatric VL in children in Alicante, Spain. Methods: The study included all paediatric (<15 years) cases admitted to three hospitals in the province of Alicante from May 1992 to May 2015 with diagnosis of VL (detection was either by anti- Leishmania antibodies in serology or Leishmania in blood and/or bone marrow aspirates). Results: There were 38 cases of pediatric VL (18 aged <24 months, 15 aged 24–59 months and 5 aged ≥5 years). The main symptoms were fever (97.4%), followed by pallor (75.0%) and loss of appetite (46.4%). Eighty-seven per cent of patients were anaemic (haemoglobin < 9 g/dL), 73.7% had neutropenia and 68.4% had thrombocytopenia. Before 2004, 92.3% of patients were treated with meglumine antimoniate (MA) and 7.7% with liposomal amphotericin B (LAmB); after 2004, 84% were treated with LAmB and just one (16%) with MA ( p < 0.001). LAmB performed better than MA in terms of mean treatment length (7.4 days vs 25.9 days, p < 0.001), time to becoming afebrile (1.7 vs 13.7 days, p < 0.001), and length of hospital stay (10.9 vs 19.4 days, p = 0.001). Conclusion: Paediatric VL in Alicante mainly affects children under five. Children aged ≤24 months present with a lower haemoglobin and white blood cell count. Treatment with LAmB reduces treatment length, time to becoming afebrile and length of hospital stay.