Pediatric visceral Leishmaniasis in Turkey

Background: Visceral Leishmaniasis (VL) type in Turkey is consistent with the Mediterranean type of VL, a fatal debilitating disease, which is mostly seen in infants. Methods: Hospital records of 19 children with VL were retrospectively reviewed. The period of the study was from January 2000 to December 2003. Results: The median age of the patients was 36 months. None was coinfected with human immunodeficiency virus or known to be immunocompromised. Fever, pallor, hepatomegaly, splenomegaly, thrombocytopenia and elevated C-reactive protein were observed in all cases, anemia in 18 (95%), leucopenia in 17 (89.4%) and elevated erythrocyte sedimentation rate in 14 (77.7%) of the cases. A bone marrow aspirate was obtained in all cases and Leishmania amastigotes were detected in 15 (78.9%). Fifteen patients (78.9%) were treated initially with meglumine antimonate and four (21%) with sodium stibogluconate. The four patients who received sodium stibogluconate suffered from adverse side-effects during treatment and were subsequently treated with lipid formulations of amphotericin B. Conclusion: Presentation of VL in the pediatric age group in Turkey is characterized by pallor, fever, splenomegaly and hepatomegaly. Hematological and biochemical indices are typical with cytopenias, hypoalbuminemia, and hyperproteinemia. In most of the cases, microscopic examination provided a positive diagnosis and the remaining patients were diagnosed by serology. Lipid formulations of amphotericin B may be useful in cases of treatment failure with antimonials or significant adverse effects of the drug.