Manifestations of paediatric Leishmania infantum infections in Malta

Abstract

SummaryLeishmania infantum is endemic in the Maltese archipelago, a group of islands in the Mediterranean which are visited frequently by tourists from Northern European countries. The burden of leishmaniasis is highest in children who may present with cutaneous or visceral manifestations. We describe systematically the manifestations, diagnosis and management of leishmaniasis in children <14 years of age, who had a histopathological diagnosis of leishmaniasis in Malta, from 2004 to 2008. Eleven children were diagnosed with leishmaniasis; 8 children (15–44 months of age) had visceral disease and three (aged 9–13 years) suffered cutaneous infections. Prolonged high grade fever, pallor, hepatosplenomegaly, and pancytopenia were common presenting features of visceralisation. Diagnosis was based on the visualisation of amastigotes from bone marrow aspirates. Pentavalent antimonials were associated with treatment failure in two children, whilst liposomal amphotericin B was curative in all. Children with cutaneous leishmaniasis had dry crusted ulcero-nodular lesions on exposed areas which responded to intra-lesional instillation of sodium stibogluconate or to cryotherapy. Leishmaniasis should be included in the differential diagnosis of fever and hepatosplenomegaly or chronic cutaneous lesions in children who travel to Malta.

American cutaneous leishmaniasis in infancy and childhood

“…26 Although L. infantum (L. chagasi) usually causes visceral diseases in children, 27 cutaneous lesions are not uncommon. 28 In addition L. infantum is known to affect a significant proportion of the infant population in certain areas of Brazil 29 highlighting the importance of asymptomatic carriers as in other parts of the world. 30 Localized cutaneous leishmaniasis has, as an etiologic agent, any member of the neotropical subgenera Viannia and Leishmania, with L (V) braziliensis, as described by some authors, one of the most important parasites associated with this form.…”

First report of sandfly fever virus infection imported from Malta into Switzerland, October 2011

“…Leishmania species are known to be transmitted by Phlebotomus perniciosus in Malta [5]. Patients were informed to remain alert for late appearing symptoms of leishmaniasis, which may not manifest until months after infection [5].…”

“…Patients were informed to remain alert for late appearing symptoms of leishmaniasis, which may not manifest until months after infection [5]. However, in the following eight months, none of the travellers developed clinical signs of leishmaniasis.…”

Cutaneous Leishmaniasis in the Nalut District, Libyan Arab Jamahiriya: A Clinico-epidemiologic Study andLeishmaniaSpecies Identification

“…4C). The mean age of those infected with L. tropica was significantly higher than of those with L. infantum (P , 0.01), known to mainly affect young children (BenSaid et al, 2006;Pace et al, 2011). In patients with L. tropica, 80 (50.0%) were 0-20 yr of age, 41 (25.6%) were 21-40 yr of age, 27 (16.9%) were 41-60 yr of age, and 12 (7.5%) were 61-80 yr of age (Table I).…”