Abstract
BackgroundVisceral Leishmaniasis (VL) is endemic in 88 countries, in areas of relatively low incidence with a relevant proportion of immune suppressed patients clinical presentation, diagnosis and management may present difficulties and pitfalls.MethodsDemographic data, clinical, laboratory features and therapeutic findings were recorded in patients identified by a regional VL disease registry from January 2007 to December 2010.ResultsA total of 55 patients (36 adults mean age 48.7 years, 19 children median age 37.5 months) were observed presenting with 65 episodes. All childen were immunocompetent, whereas adults affected by VL included both immunocompetent (n°17) and immunesuppressed (n°19) patients. The clinical presentation was homogeneous in children with predominance of fever and hepato-splenomegaly. A wider spectrum of clinical presentations was observed in immunocompromised adults. Bone marrow detection of intracellular parasites (Giemsa staining) and serology (IFAT) were the most frequently used diagnostic tools. In addition, detection of urinary antigen was used in adult patients with good specificity (90%). Liposomal amphotericin B was the most frequently prescribed first line drug (98.2% of cases) with 100% clinical cure. VL relapses (n°10) represented a crucial finding: they occurred only in adult patients, mainly in immunocompromised patients (40% of HIV, 22% of non-HIV immunocompromised patients, 5,9% of immunocompetent patients). Furthermore, three deaths with VL were reported, all occurring in relapsing immunocompromised patients accounting for a still high overall mortality in this group (15.8%).ConclusionsThe wide spectrum of clinical presentation in immunesuppresed patients and high recurrence rates still represent a clinical challenge accounting for high mortality. Early clinical identification and satisfactory treatment performance with liposomal amphotericin B are confirmed in areas with low-level endemicity and good clinical standards. VL needs continuing attention in endemic areas where increasing numbers of immunocompromised patients at risk are dwelling.
Highlights
Visceral Leishmaniasis (VL) is endemic in 88 countries, in areas of relatively low incidence with a relevant proportion of immune suppressed patients clinical presentation, diagnosis and management may present difficulties and pitfalls
Leishmaniasis is a complex of mammalian diseases caused by protozoans classified as Leishmania species (Order:kinetoplastida Family:trypanosomatidae) [1,2]
Natural transmission may be zoonotic or anthroponotic, and occurs through the bite of a phlebotomine sandfly species of the genus Phlebotomus and Lutzomyia [3,4] with the domestic dog as the main reservoir for visceral disease in the Mediterranean basin but in other hyperendemic areas humans act as the main reservoir
Summary
Visceral Leishmaniasis (VL) is endemic in 88 countries, in areas of relatively low incidence with a relevant proportion of immune suppressed patients clinical presentation, diagnosis and management may present difficulties and pitfalls. Natural transmission may be zoonotic or anthroponotic, and occurs through the bite of a phlebotomine sandfly species (order Diptera) of the genus Phlebotomus (old world) and Lutzomyia (new world) [3,4] with the domestic dog as the main reservoir for visceral disease in the Mediterranean basin but in other hyperendemic areas (or instance Sudan or India) humans act as the main reservoir. Incidence of leishmaniasis in humans is relatively low, ranging from 0.2 × 10-6 to 0.49 × 10-6 (85.3 × 10-6 including Turkey). This estimate corresponds to 700 reported new cases per year in Southern Europe (3,950/yr if Turkey is included). Population movements, dog and vector mobility may contribute to the spread
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