Pediatric Visceral Leishmaniasis in Albania: A Retrospective Analysis of 1,210 Consecutive Hospitalized Patients (1995–2009)

Abstract

BackgroundLittle information is available about infantile visceral leishmaniasis (VL) in Albania as regards incidence, diagnosis and management of the disease.Methodology/Principal FindingsDemographic data, clinical and laboratory features and therapeutic findings were considered in children admitted to University Hospital of Tirana from 1995 to 2009, and diagnosed as having VL. The diagnosis was based on bone-marrow microscopy/culture in 77.5% of patients, serology in 16.1%, and ex juvantibus in 6.4%. A total of 1,210 children were considered, of whom 74% came from urbanized areas. All patients were in the age range 0–14 years, with a median of 4 years. Hepatosplenomegaly was recorded in 100%, fever in 95.4% and moderate to severe anemia in 88% of cases. Concomitant conditions were frequent: 84% had bronchopneumonia; diarrhea was present in 27%, with acute manifestations in 5%; 3% had salmonellosis. First-line therapy was meglumine antimoniate for all patients, given at the standard Sbv dosage of 20 mg/kg/day for 21 to 28 days. Two children died under treatment, one of sepsis, the other of acute renal impairment. There were no cases of primary unresponsiveness to treatment, and only 8 (0.67%) relapsed within 6–12 months after therapy. These patients have been re-treated with liposomal amphotericin B, with successful cure.ConclusionsVisceral leishmaniasis in pediatric age is relatively frequent in Albania; therefore an improvement is warranted of a disease-specific surveillance system in this country, especially as regards diagnosis. Despite recent reports on decreased responses to antimonial drugs of patients with Mediterranean VL, meglumine antimoniate treatment appears to be still highly effective in Albania.

Hematological profile in visceral leishmaniasis

“…Positive findings like pallor, splenomegaly, hepatomegaly were observed but less common than to the Dash S et al 7 and Hamid GA et al 18 Visceral leishmaniasis should be strongly suspected in patients with unexplained fever, being longer than 2 weeks, pallor, splenomegaly, hepatomegly and potential exposure in an endemic area or from areas from where On complete blood count (CBC), the majority of patients had anemia, leucopenia, and thrombocytopenia (90%, 67.5% and 72.5%, respectively) followed by neutropenia (27.5%), and lymphocytosis (65%). Similar finding were observed by various authors such as Dash S et al 7 , Singh K et al, 12 and Petrela R et al 20 series have reported a normocytic normochromic anemia in peripheral smear examination. 11,13,14 In this study we observed normocytic normochromic and anisocytosis hypochromic in equal frequency (35%) followed by anisopoikilocytosis hypochromia (20%), normocytic hypochromia (5%) and anisopoikilocytosis normochromic (2.5%).…”

Paediatric Visceral Leishmaniasis in Italy: a ‘One Health’ approach is needed

“…Importantly, in a recent study, Phlebotomus perniciosus and Phlebotomus neglectus , both competent vectors of L. infantum [9], were found in the same region, with the highest abundance recorded in July and August [10]. This explains the common onset of the disease during the summer, as reported in other studies carried out in the Mediterranean region [4-6]. …”

“…In this case, collecting information on the summer stay of the child at a seaside locality, apparently one of the commonest habits of middle class families in this part of Italy, eventually turned out to be pivotal anamnestic data, leading physicians to the correct interpretation of clinical and laboratory findings. In Italy, as well as in other southern European countries, the majority of patients diagnosed and treated for VL are indeed children aging under or equal to 3 years [4-6], due to the immaturity of their immune system [7]. Noteworthy, the name ‘ infantum ’ was initially attributed to this Leishmania species for causing a visceral syndrome predominantly in infants in the Mediterranean region.…”

Clinical aspects of paediatric visceral leishmaniasis in North‐west Ethiopia

“…In contrast, lymphadenopathy is very common (72%) among children with VL in Sudan (Siddig et al 1990) that shares the same etiologic agent (L. donovani) as Ethiopia. On the other hand, Mediterranean paediatric VL (caused by Leishmania infantum) is characterised by low prevalence of lymphadenopathy (0% among Sicilian patients; Cascio et al 2002), 11% among Albanian patients (Petrela et al 2010). This difference remains unexplained.…”