Bacterial infections in children with visceral leishmaniasis: observations made in Kerman province, southern Iran, between 1997 and 2007

Cases of human visceral leishmaniasis (VL) are often found to have bacterial infections. Between 1997 and 2007, 60 cases of VL were admitted to the paediatric ward of the Afzalipour Medical Centre, which forms part of the Kerman University of Medical Sciences, in southern Iran. On admission, the 60 cases (39 boys and 21 girls), each of which was confirmed by the demonstration of amastigotes in a bone-marrow aspirate, had a mean (S. D.) age of 48.8 (44.4) months and a mean (S. D.) erythrocyte sedimentation rate of 53.2 (34.2) mm/h. Twenty-five (42%) of the cases (14 boys and 11 girls) were found to have bacterial infections. Urinary infections (seen in 36% of the cases with bacterial infection) were the most common, followed by blood (28%), respiratory (16%), gastro-intestinal (12%) and skin infections (8%). Despite treatment of all the VL cases with meglumine antimoniate, four (7%) died on the paediatric ward, all four having concurrent bacterial infections. The leucopenia and immunosuppression associated with VL probably facilitate the development of fatal bacterial co-infections. The prompt diagnosis and treatment of both the VL and any bacterial co-infections should therefore reduce mortality among VL cases.