Pediatric visceral leishmaniasis in southern France

Purpose. The purposes of this study were to describe the characteristics of pediatric visceral leishmaniasis in southern France and to evaluate a new scheme of therapy. Methods. Hospital records of 59 children with visceral leishmaniasis were retrospectively reviewed, The period of the study was from 1981 to 1997. Results. All children but one lived or had previously dwelled in the south of France. None was coinfected with human immunodeficiency virus or known to be immunocompromised. The mean age was 31 months; 10 children were younger than 1 year when admitted to the hospital. The male:female ratio was 0.73, Fever and splenomegaly mere present in 90 and 100%, respectively. Anemia, leukopenia and thrombocytopenia were commonly observed, especially in the youngest patients. Hypergammaglobulinemia was noted in 64%. A biopsy sample of the bone marrow was always performed, but direct microscopic examination failed to identify Leishmania in 13 (22%) cases. In these patients specific serology and genomic amplification with polymerase chain reaction were useful tools for the diagnosis. All patients were initially treated with meglumine antimonate (Glucantime((R))). Twenty-six (44%) patients receiving the drug experienced at least one adverse event during treatment. Treatment failure occurred in six children (10%), who were subsequently cured with liposomal amphotericin B. Three additional children were treated with liposomal amphotericin B. All the children were finally cured and no death was observed. Conclusion. Our experience suggests that liposomal amphotericin B is effective therapy for visceral leishmaniasis in children.