Clinical and Epidemiological Aspects of Visceral Leishmaniasis in Wasit Governorate

Abstract

A prospective study was conducted on (864) patients with history of prolonged fever who were admitted in hospitals of Wasit governorate over (36) months in the period from 1st January 2006 to 31st December 2008. A presumptive diagnosis of visceral leishmaniasis (V.L.) was done depending on clinical examination which was confirmed by laboratory methods (Complete Blood Picture, rk39 Dipstick, IFAT). In this study (900) blood samples were tested serologically by using both rK39 Dipstick and IFAT ;( 864) samples out of the total samples were diagnosed as having V.L. by classic clinical presentation, while( 36 ) samples were without presumptive diagnosis of V.L. (used to clarify the specificity of rK39 Dipstick & IFAT) .Eight hundred-seven samples from patients with suspected V.L. were serologically positive ; the rest (57) samples and all the( 36) samples from patients without suspicion of V.L. were negative.All seronegative patients were excluded from this study . In this study males constituted 50.4% and females constituted 49.6% of the total sample included, and the male: female ratio was 1.02:1. The majority of cases of V.L.(52.41%) were between the age of (1-2) years & the second major group of patients (32.72%) was < 1 year . Heavy infection appeared in Winter (46.96%) and decline in late Autumn (9.79%) , with about one quarter of cases registered during February, and another peak in January. There was a decrease in the number of reported cases of V.L. in Wasit governorate in 2008 compared to 2006 . The highest number of cases registered were from Al-Sowaira (46.47%) and Al-Azizia (35.56%) sub-districts ; with the least number of cases from Badra (0.25%) . The majority of patients (48.08%) took 2-6 months to present with the full blown picture of V.L. The main presenting symptom was fever which was seen in all cases (100%) and the main sign was splenomegaly which was detected in (81.9%) .A large number of patients presented with more than one sign and symptom. Pallor was apparent in 87.1% of patients with muscle wasting &malnutrition in 60.5% .Anemia was detected in 90.5% of patients which was severe to moderate in 60.5% and 416 of patients(51.5%) needed blood transfusion. Leucopenia was evident in the majority of patients (76.3%) and about 12% of patients developed severe thrombocytopenia & about half the patients with mild to moderate thrombocytopenia . The sensitivity of the rK39 Dipstick test was 90.39% , and the specificity was 100 % while the sensitivity of IFAT was 71.99%, and specificity was 100%. Thirty-nine patients died in hospitals (4.83%); pneumonia and septicemia were the leading causes of mortality .