Pediatric visceral leishmaniasis in northwest of Iran

Abstract

Leishmaniasis is one of the major health problems in Iran. Although the incidence of visceral leishmaniasis (VL) is reported almost everywhere, the northwestern Iran is one of the major endemic regions.To do this study, clinical, laboratory as well as disease characteristics of children admitted to Children Cure and Health Hospital, Tabriz University of Medical Sciences, were examined as the reference hospital for the treatment of VL in northwestern Iran.In this study, 156 children hospitalized in a pediatric hospital from 2000 to 2015 for VL were included. Gender, age, anemia, thrombocytopenia, increase in the erythrocyte sedimentation rate (ESR), alanine transaminase (SGPT), and aspartate transaminase (SGOT), major clinical manifestations such as fever, splenomegaly, hepatomegaly, treatment type, and the disease were studied.Among 156 patients examined in this study, 88 (56.41%) and 68 (43.59%) participants were male and female, respectively. The minimum and maximum ages of the infection were 4.5 months and 6 years, respectively. The mean age of the infected children was 17.94 months. Fever (94.24%) and splenomegaly (86.53%) were the most common symptoms of this disease among children. In addition, 49 (31.41%), 64 (41.02%), 18 (11.53%), 33 (21.15%), and 40 (25.64%) participants had leukopenia, hemoglobin count below 8, ESR above 100, ESR above 60, and platelets below 100,000, respectively. Moreover, 39 (25%) and 17 (10.89%) patients had high aspartate transaminase (AST) and alanine transaminase (ALT). Also, 96.2% of the participants responded to the treatment with glucantime. The rate of mortality in this study was 3.2%.Clinically, almost all children had fever and splenomegaly at the onset of the disease. In addition, hepatic involvement was observed in all cases of mortality, cases with a lack of initial response, and those in need of auxiliary medication. Hepatic involvement appears to be related to the prognosis of the disease. In our study, bone marrow aspiration (BMA) and positive direct antiglobulin test (DAT) were observed in 66.67% and more than 90% of the patients, respectively.Children with VL in northwestern Iran responded well to glucantime. In case of resistance, amphotericin B was a good alternative. Early diagnosis is essential in reducing mortality rate.

Molecular Characterization of Visceral Leishmaniasis in Asymptomatic Dogs in North Khorasan, Northeastern Iran

“…Despite the visceral leishmaniasis infection age distribution throughout Iran in previous studies (12), our findings showed that most of the studied dogs were less than five-years-old, but the highest number of infections was in the age group of 5 -10 years, which probably indicates that this age group is more sensitive to visceral leishmaniasis in this region. Although the bone marrow and lymph nodes have many parasites, according to studies, conjunctiva, oral mucosa or snout and blood are both reliable and suitable for molecular studies because the sample source in dogs is important for accurately determining the contamination.…”

Visceral Leishmaniasis in Children in Southern Turkey: Evaluation of Clinical and Laboratory Findings and Liposomal Amphotericin B Treatment

“…Anemia, slight-to-moderate liver enzyme elevation, and increased ESR and CRP were present in all (100%) of our patients at presentation, which conforms to the majority of previous studies (1,5,13). However, in a study by Abdinia et al (6), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) elevation were reported in only 25% and 11% of patients, respectively. This can be seen as a major difference, especially considering that the study in question was performed in a region that neighbors the south-eastern region of Turkey (Northwest of Iran).…”

“…Lymphadenopathy was the third most common finding in our study group with a frequency of 50%, however, Miao et al (10) reported that it was present in only 33% of their patients. In the current study, bleeding manifestations were observed in the form of petechiae in 2 (11.1%) patients, Krepis et al (11) reported bleeding manifestations in 7% of their patients (12), while Abdinia et al (6) reported petechiae and purpura in 11.5% of their study group. The classic triad of VL is comprised of fever, splenomegaly and pallor (13,14).…”

“…However, the frequency of hepatomegaly (100%) in the current study group was relatively high compared to studies by Krepis et al (11) (58.1%), Abdinia et al (6) (51.3%) and Miao et al (10) (74%). It is also important to note that Abdinia et al (6) found that liver involvement was present in all cases of mortality in their patient group. Lymphadenopathy was the third most common finding in our study group with a frequency of 50%, however, Miao et al (10) reported that it was present in only 33% of their patients.…”

Visceral Leishmaniasis Treatment Outcome and Associated Factors in Northern Ethiopia

“…Poor treatment outcome related to the delay in diagnosis was reported in other similar studies [25, 31]. The implication of this finding is the importance of early diagnosis, as the disease is completely curable with timely treatment [32]. Furthermore, transmission can be reduced through early case detection followed by complete treatment [10].…”