Risk factors for mortality of children with zoonotic visceral leishmaniasis in Central Tunisia

Abstract

BackgroundZoonotic visceral leishmaniasis (ZVL) caused by Leishmania infantum is endemic with an epidemiological profile of a paediatric disease in Tunisia. In the context of a high fatality rate, identifying risk factors for in-hospital mortality in children treated for ZVL is of major epidemiological importance.DesignA retrospective (case-control) study included 230 immuno-competent children diagnosed and confirmed with primary ZVL in the paediatric department of the University Hospital of Kairouan between 2004 and 2014. Forty-seven per cent (47%) were children under 18 months of age, and with a male ⁄ female ratio of 1.01:1.ResultsThe overall case-fatality was 6% (n = 14). The risk factors for in-hospital death identified by a multivariate analysis were: bleeding at admission (OR = 25.5, 95% CI: 2.26–287.4; p = 0.009), white cell count less than 4000/mm3 (OR = 5.66, 95% CI: 1.16–27.6; p = 0.032), cytolysis (OR = 28.13, 95% CI: 4.55–173.6; p < 0.001), and delay between onset of symptoms and admission ≥ 15 days (OR = 11, 95% CI: 1.68–72; p = 0.012).ConclusionThe results strongly suggest that paediatric patients admitted 15 days after onset of symptoms, with bleeding, white cell counts below 4,000/mm3, and cytolysis at admission should be considered severe cases and subsequently, they are at high risk of mortality. A better understanding of factors associated with death of children from ZVL may contribute to decrease mortality.

Enhanced attraction of sand fly vectors of Leishmania infantum to dogs infected with zoonotic visceral leishmaniasis

“…The incidence of ZVL is highest among children between 1 and 2 years of age [4]. In a previous study, we showed that paediatric patients admitted 15 days after onset of symptoms, with bleeding, white cell counts below 4,000/mm 3 , and cytolysis at admission should be considered severe cases and subsequently, they are at high risk of mortality [7].…”

Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection

“…Leishmania infection is a well-known cause of infection associated HLH [4,[8][9][10][11]. It was reported that about 25.77% of patients with adult hemophagocytic syndrome were induced by Leishmania infection [12]. As many as 41.7% of children with visceral leishmaniasis developed HLH if lack of timely treatment and the mortality rate was as high as 100% [4,9].…”

Fatal Visceral Leishmaniasis Caused byLeishmania infantum, Lebanon

“…However, L. infantum , which undergoes zoonotic transmission, is associated with fewer deaths and is endemic to Latin America and the Middle East ( 4 ). This species shows a mortality rate of 6% for children ( 5 ).…”