Leishmaniose visceral em paciente pediátrico com recuperação medular pós-tratamento com uso de Filgastrim

Abstract

Visceral leishmaniasis (VL) is a chronic systemic infectious disease caused by protozoa of the family Trypanosomatidae, genus Leishmania. Death is the outcome in more than 90% of the cases when the disease is left untreated. One of the characteristics of VL is the higher incidence of disease and death in younger children, due to the greater susceptibility to infection and immune disorder observed in this age group. VL is still a neglected disease, with high incidence and high mortality, which calls for substantial improvements in diagnosis and treatment, especially in the pediatric population. There are few drugs available for the treatment of VL. The first choice in Brazil is N-methyl-glucamine antimoniate, known for its toxicity and long treatment protocol. The second option is liposomal amphotericin B or amphotericin B deoxycholate, which produce fewer side effects, although they are prescribed to fewer patients. This report describes the case of a child with symptoms progressing for three months, in addition to pancytopenia, and liver failure, diagnosed and treated with liposomal amphotericin B. Since the patient remained with severe neutropenia, a therapeutic test with filgrastim was performed and led to good platelet recovery. Neutropenia is a characteristic sign of Leishmaniasis, which usually resolves rapidly once treatment has been initiated. Some patients remain with severe neutropenia, and further studies are needed to define the actual benefit of using granulocyte-colony stimulating factor in order to reduce the length of hospital stay.