Visceral Leishmaniasis In Children Research Articles

Differential diagnosis of visceral leishmaniasis in children: a five-year retrospective study at a pediatric referral hospital

BackgroundVisceral leishmaniasis (VL) is a zoonotic disease caused by protozoa of the genus Leishmania and is transmitted by sandflies of the genus Lutzomyia. Children under 15 years are disproportionately affected. In pediatric patients, the clinical and laboratory features of VL often overlap with those of other infectious and hematology-oncology diseases, making differential diagnosis challenging. Rapid and accurate identification of VL is critical for effective treatment. This study aimed to evaluate the epidemiological, clinical, and laboratory characteristics of pediatric patients initially suspected of having VL and to compare their final diagnoses upon discharge from a referral hospital.MethodsWe retrospectively analyzed medical records of children with suspected VL, admitted between July 2014 and June 2019.ResultsInfectious diseases were confirmed in 61% of cases (86 patients), with VL confirmed in 55 cases. Hematology-oncology diseases were the second most common diagnosis, affecting 22.7% of patients (32 cases). Comparisons between the VL-confirmed group and those with other diagnoses revealed no significant age difference (p = 0.690). However, female sex, spleen size, and leukopenia were identified as significant predictors of VL.ConclusionsFemale sex, spleen size, and leukopenia were key predictors for differentiating VL from other pediatric diseases in a referral center in the Northeast Region of Brazil.

Seroprevalence of Visceral Leishmaniasis in Children Up To 12 Years Old of Rural Areas from Kermanshah Province, Western Part of Iran.

After the earthquake in 2017 a few new cases of visceral leishmaniasis (VL) were reported from SarPol-e-Zahab district of Kermanshah Province, western part of Iran. This study was conducted to determine the seroprevalence in Kermanshah Province. This descriptive cross-sectional study was conducted on children up to 12 years of age from SarPol-e-Zahab County, Kermanshah Province, western part of Iran in 2021. For each individual, a questionnaire including age, sex, clinical features, history of the disease, and contact with canines as reservoir hosts of VL were completed, separately. To determine VL seroprevalence, blood samples were collected from the children and after centrifugation, the sera samples were separated and tested using Direct Agglutination Test (DAT) for detection of anti-L. infantum antibodies. Statistical analyses were performed using SPSS16. Totally, 13 persons were seropositive; 7 samples with titer 1:800, 3 samples had 1:1600, 2 samples had 1:3200 and 1 sample had 1:6400. None of the seropositive cases had a history of kala-azar. There was no significant difference between males and females at titers of anti-Leishmania specific antibodies. L. infantum infection is being circulated with low prevalence in children up to 12 years old from SarPol-e-Zahab County but it is necessary that the surveillance system is regularly monitored among physicians and public health managers in the studied areas.

SEROPREVALENCE OF VISCERAL LEISHMANIASIS AND ITS ASSOCIATED FACTORS AMONG ASYMPTOMATIC CHILDREN IN HADHRAMOUT VALLEY AND DESERT REGIONS, YEMEN

Background and Aims: Visceral leishmaniasis (VL) is zoonotic and human illness produced by Leishmania species. Protozoan parasite is spread to the host vertebrate via sand fly female bite (Phlebotomus longipalpis), in which the infected promastigotes convert into amastigotes; and VL is associated with high fatality if left untreated. The aims of the current study were to uncover the prevalence and potential risk factors for VL in children in selected districts of Hadhramout governorate, Yemen. Subjects and methods: Six districts were randomly selected from 24 districts in Hadhramout governorate as follows: Al-Sum, Al-Qattan, Tarim, Thamud, Seiyun, and Shibam. Then a target sample size of 400 children were randomly selected, 66 children were selected from each district except 70 children in Seiyun and they were selected from the selected schools and health centers. Serum specimens were assemble from all children to determine the rate of anti-VL antibodies in human by immunochromatographic assay using recombinant K39 antigen. Results: The age of the children from 1-15 years, by a mean of 8.4±2.7 years. The positivity rate of Leishmania species antibodies by immune-chromatographic dipstick strip (rK39) was 5.8%. There was statistically considerable association connecting male gender and VL infection (8.0%, OR=3, CI=1.1-8.2, p=0.02). There was statistically important association linking older children (11-15 years( and contracting VL (9.1%, OR=2.6, CI=1.1- 6.2, p=0.02). There was a considerable association (<0.05) connecting the presence of rats, dogs, and goats in or around live houses and positive VL antibodies with an OR come to to 2.6, 3.7 and 2.8, respectively. There was no significant association between displacement or district location and incidence of VL. Conclusion: Visceral leishmaniasis was highly prevalent in the desert and the valley areas of Hadramout among children, and visceral leishmaniasis potential risk factors were males, older children, dogs, rats, goats, litter, open sewers, and the presence of sand flies in the household. Peer Review History: Received: 8 November 2022; Revised: 12 December; Accepted: 5 January 2023, Available online: 15 January 2023 Academic Editor: Dr. Nuray Arı, Ankara University, Turkiye, ari@ankara.edu.tr Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Rola Jadallah, Arab American University, Palestine, rola@aauj.edu Similar Articles: PREVALENCE OF VISCERAL LEISHMANIASIS AMONG ADULTS IN SANA’A CITY-YEMEN COUMARIN ANALOGUES AS A POTENTIAL INHIBITOR OF LEISHMANIASIS: A MULTI-TARGETING PROTEIN INHIBITION APPROACH BY MOLECULAR DOCKING IN VITRO ANTI-LEISHMANIAL ACTIVITY AGAINST CUTANEOUS LEISHMANIA PARASITES AND PRELIMINARY PHYTOCHEMICAL ANALYSIS OF FOUR YEMENI MEDICINAL PLANTS

Autochthonous visceral leishmaniasis in the Russian Federation and the role of polymerase chain reaction as an alternative diagnostic method

The aim of the work is to summarize the available literature data on cases of visceral leishmaniasis in children registered in the Russian Federation, as well as to describe our own clinical observation of autochthonous visceral leishmaniasis in a 9-year-old child, in the diagnosis of which the polymerase chain reaction (PCR) method was used.Materials and methods: a review of domestic and foreign literature over the past 20 years, including Internet resources, was carried out. We observed a 9-year-old child hospitalized in the Russian Children's Clinical Hospital. Leishmania DNA was determined in blood serum by PCR using the Amplisens – Leishmania-Fl reagent kit.Results. It was established that the infection of the patient observed by us occurred on the territory of the Russian Federation in the Crimea. The diagnosis of leishmaniasis was confirmed by morphological examination of the bone marrow and the detection of pathogen DNA in the blood serum by PCR.Conclusion. On the territory of the Russian Federation there are foci of autochthonous visceral leishmaniasis in the Crimea and the North Caucasus. Polymerase chain reaction is an alternative to bone marrow aspirate microscopy for the diagnosis of visceral leishmaniasis.

Molecular and serological evaluation of visceral leishmaniasis in domestic dogs and cats in Maragheh County, north-west of Iran, 2018-2021.

ObjectiveZoonotic visceral leishmaniasis (VL) is caused by Leishmania infantum, of which dogs are the main reservoir. VL is endemic in the Middle East, also in some parts of Iran. Following reports of new cases of VL in children in Maragheh County, the non‐endemic area of the disease, we encouraged to conduct a preliminary study on domestic dogs and cats to identify their potential role as reservoirs for the disease.Materials and MethodsThis study was conducted during a period of 3 years from 2018 to 2021. Two hundred ownership dogs and 25 cats from Maragheh County, north‐west of Iran, were randomly screened. Blood samples were collected. A direct agglutination test (DAT) was used for the detection of anti‐L. infantum antibodies. Furthermore, buffy coat samples from the L. infantum seropositive animals were examined to detect parasite presence using polymerase chain reaction.ResultsOut of the total of 200 ownership dogs evaluated, 170 (85%) were male and 30 (15%) were female with a mean age of 4.3 years. Anti‐L. infantum antibodies (IgG cut‐off ≥ 1:320) were observed in 3.5% of dogs (7/200) by the DAT test. All seropositive dogs were identified in the first year of examination. Regarding molecular approaches in seropositive dogs, two samples were positive for a 565 bp kDNA minicircle gene specific for L. infantum. During the study period, no seropositive case was detected in the cats examined.ConclusionsThis study shows that the domestic cycle of L. infantum has been established in the studied region. It is necessary to increase the awareness and monitoring of the disease with the study of wild reservoirs periodically.

Seroprevalence of visceral leishmaniasis in children living in rural areas of Ahar and Osku Counties in East Azarbaijan Province, North-west of Iran in 2018

Background: Visceral leishmaniasis (VL) or Kala-azar is an endemic disease in some areas of Iran, including East Azarbaijan, Ardabil, Fars and Bushehr provinces. The disease is sporadic in other parts of the country. According to the reports of numerous cases of the disease from Ahar and Osku counties (cities), East Azarbaijan province and the lack of new study on the prevalence of the disease, this study was designed to determine the seroprevalence of VL in the children of Ahar and Osku counties, in East Azarbaijan Province. Methods: In this descriptive cross-sectional study, blood samples were collected in the test tube without anticoagulants, from children under 8 years from rural areas of Ahar and Osko, in 2018. The samples were evaluated using Direct Agglutination Test (DAT) to measure anti Leishmania infantum antibodies for titer up to 1:3200. Results: Out of 209 children <8 years in selected centers in Ahar and Osku, two cases (0.95%) revealed anti-Leishmania antibodies titer 1:3200. Initially, one of the two positive individuals in the study had a suspicious antibody titer of 1:1600, whose antibody titer increased to 1:3200 after 4 weeks. Conclusion: The Kala-azar, in spite of low endemicity, is one of the health problems in Ahar and Osku in East Azarbaijan Province. This study suggests the necessity of supplementary studies based on molecular approaches in the region and other parts of the province.

Childhood visceral leishmaniasis in Tunisia: A cross-sectional study in local spatial analysis

This paper describes spatial distribution of Visceral Leishmaniasis (VL) and determines its correlation with climatic factors in an endemic focus in northern and central Tunisia. Data on VL cases in children under five years of age were obtained by consulting medical reports from all Tunisian Pediatric Departments (TPD) during 2006–2016. Three key climatic factors, namely precipitation, continentality index and pluviometric coefficient of Emberger were used as predictor variables to model the VL geographical distribution. Data handling and statistical analysis were performed using R and Arcview GIS software systems. Bayesian local spatial model was employed to analyse the data. The results show a progressive increase in the VL incidence rates in regions with high levels of precipitation, but with low values of both continentality index and pluviometric coefficient of Emberger. A likely explanation of these findings arises from the opposite local effects of climatic factors which tend to cancel each other out in the calculation of the mean parameter estimate over the whole study area. We conclude that using non-local spatial analysis approach leads to misleading epidemiological interpretations, which in turn are of relevance for more efficient and cost-effective resource allocation for control and well manage the spread of VL in the study region and elsewhere in Tunisia.

Clinical and Epidemiologic Features of Visceral Leishmaniasis in Children: A 6-year Study from an Iranian Referral Hospital.

Visceral leishmaniasis (VL) is an emerging zoonosis disease that is endemic in the northwestern and southern part of Iran. This study aimed to evaluate the clinical characteristics and laboratory findings of the children with VL hospitalized at Children Medical Center Hospital (CMC), Tehran, Iran. A retrospective study was performed based on studied medical records of children with a final diagnosis of VL from 2011 to 2016. For each patient's demographics, clinical laboratory findings and treatment were examined. The clinical features of 17 children were examined and the most frequent symptoms were fever (94.1%, n=16), pallor, loss of appetite (76.5%, n=13), splenomegaly (82.4%, n=14) and hepatomegaly (58.8%, n=10). The most frequent laboratory abnormalities were hematological including anemia (94.1%, n=16), leukopenia (52.9%, n=9) and thrombocytopenia (70.5%, n=12). In order to detect anti-Leishmania antibodies, DAT was performed in 11 patients and 82% of them were positive (titers ≥ 1: 3200). In addition, rK39 was used in 9 cases and 7 children (78%) had positive results. Direct parasitology revealed the presence of amastigotes of Leishmania in bone marrow aspirate (BMA) stained by Giemsa stain in 9 patients (69%, among 13 children). Leishmaniasis is a regional disease therefore management and control of disease, particularly in an endemic area, as well as detection of new emerging foci are recommended.

Clinical and Laboratory Findings of Visceral Leishmaniasis in Children Hospitalized in Mashhad, Northeastern Iran: A Twenty-Year Retrospective Study

Background:Over the last decade, a few cases of visceral leishmaniasis (VL) have been reported in some provinces of northeastern Iran. We aimed to investigate clinical and laboratory findings of VL among children who admitted to the pediatric ward in a referral hospital in Mashhad, northeastern Iran.Methods:A retrospective study, between 1997 and 2017, was performed on the data sheet registered for children with confirmed VL at the referral Emam Reza Hospital in Mashhad. Hematological and biochemical profiles of the patients were analyzed.Results:A total of 35 children with VL, confirmed by the presence of amastigotes of Leishmania in Giemsa stained smears of the bone marrow, had been recorded through 20 yr. The mean age of patients was 3.7±4 yr. The majority of the patients suffered from hepatosplenomegaly (100%, n=35/35), followed by prolonged fever and pallor (91%, n=32/35), weight loss (85%, n=30/35). The main laboratory findings were anemia (94.1%), leukopenia (52.9%) and thrombocytopenia (70.5%). Almost one-third (37.1%; 13/35) of VL patients inhabited in rural areas of the Bojnoord district as a known VL endemic focus in northeastern Iran.Conclusion:Our preliminary data showed that the origin of VL is still in some districts other than Mashhad, where VL just will be diagnosed.

Clinical and Epidemiologic Features of Visceral Leishmaniasis in Children: A 6-year Study from an Iranian Referral Hospital

Clinical and Epidemiologic Features of Visceral Leishmaniasis in Children: A 6-year Study from an Iranian Referral Hospital

Visceral Leishmaniasis in Children in Southern Turkey: Evaluation of Clinical and Laboratory Findings and Liposomal Amphotericin B Treatment

Visceral Leishmaniasis in Children in Southern Turkey: Evaluation of Clinical and Laboratory Findings and Liposomal Amphotericin B Treatment

Molecular diagnosis of visceral leishmaniasis in children of Basrah governorate, Iraq

Molecular diagnosis of visceral leishmaniasis in children of Basrah governorate, Iraq

Unusual manifestations of visceral leishmaniasis in children: a case series and its spatial dispersion in the western region of S\xe3o Paulo state, Brazil

BackgroundVisceral leishmaniasis (VL) is becoming endemic in São Paulo state, in the southeastern region of Brazil. Unusual manifestations with non-specific signs and symptoms may make diagnosis difficult and delay treatment, increasing the risk of severity and death, particularly in new endemic areas. There are few studies on patients with these characteristics in Brazil. We describe a case series of unusual manifestations of VL in children and its spatial dispersion in the western region of São Paulo state.Cases presentationFrom 2009 to 2014, five clinical cases involving children treated in the Regional Hospital of Presidente Prudente (RH) were selected. Two patients had multiple relapses requiring liposomal amphotericin B; one patient had VL-cytomegalovirus-dengue co-infection and liver injury; one patient was diagnosed with X-linked agammaglobulinemia, a primary immunodeficiency; and one patient was diagnosed with VL-human immunodeficiency virus/acquired immunodeficiency syndrome (VL-HIV/AIDS) co-infection. Primary or secondary immunodeficiencies were found in four children, and associated viral infections were found in three children. Three patients were referred from other hospitals to RH. With regard to the geographic spread of VL, more cases were found in the northern area, in the epicenter of the infection where the first cases were registered, flowing south; a spatial-temporal occurrence was found.ConclusionsPrimary and secondary immunodeficiencies and viral co-infectious should be considered among unusual manifestations of VL, especially in those with multiple relapses. Spatial-temporal occurrence was found. Thus, integrated actions and effective monitoring of the disease are needed to complement curative practices to stem the tide of the epidemic.

Potential role of zinc in the visceromegaly regression and recovery of hematological parameters during treatment of visceral leishmaniasis in children from an endemic area.

ABSTRACTLeishmaniasis is a disease complex with various clinical symptoms caused by different species of parasites of the genus Leishmania. The visceral form of the disease, characterized by severe symptoms is fatal, if not treated. The high toxicity of current antileishmanial drugs and the need for long-term treatment make the therapy complicated, especially in a large number of infected children. Hence, the search for new therapies must be intensified. Oral administration of the trace element zinc has been considered in alternative treatments against different clinical forms of leishmaniasis. This study revealed that the administration of zinc in children with visceral leishmaniasis, during treatment with amphotericin B or glucantime, accelerates the regression of the spleen enlargement without interfering with the recovery of hematological parameters.

Epidemiological and clinical features of visceral leishmaniasis in children in Alicante Province, Spain

Background: Visceral leishmaniasis (VL) is endemic to the Mediterranean basin. In children, VL often presents with non-specific symptoms and can be life-threatening without proper treatment.Aim: To describe the epidemiological and clinical features of pediatric VL in children in Alicante, Spain.Methods: The study included all paediatric (<15 years) cases admitted to three hospitals in the province of Alicante from May 1992 to May 2015 with diagnosis of VL (detection was either by anti-Leishmania antibodies in serology or Leishmania in blood and/or bone marrow aspirates).Results: There were 38 cases of pediatric VL (18 aged <24 months, 15 aged 24–59 months and 5 aged ≥5 years). The main symptoms were fever (97.4%), followed by pallor (75.0%) and loss of appetite (46.4%). Eighty-seven per cent of patients were anaemic (haemoglobin < 9 g/dL), 73.7% had neutropenia and 68.4% had thrombocytopenia. Before 2004, 92.3% of patients were treated with meglumine antimoniate (MA) and 7.7% with liposomal amphotericin B (LAmB); after 2004, 84% were treated with LAmB and just one (16%) with MA (p < 0.001). LAmB performed better than MA in terms of mean treatment length (7.4 days vs 25.9 days, p < 0.001), time to becoming afebrile (1.7 vs 13.7 days, p < 0.001), and length of hospital stay (10.9 vs 19.4 days, p = 0.001).Conclusion: Paediatric VL in Alicante mainly affects children under five. Children aged ≤24 months present with a lower haemoglobin and white blood cell count. Treatment with LAmB reduces treatment length, time to becoming afebrile and length of hospital stay.

Childhood Visceral Leishmaniasis: Distinctive Features and Diagnosis of a Re-emerging Disease. An 11-year Experience From a Tertiary Referral Center in Athens, Greece.

Visceral leishmaniasis (VL) remains a public health issue in Greece. The aim of this study was to describe the clinical and epidemiologic characteristics of pediatric VL in our region as well as to evaluate the laboratory findings and the diagnostic techniques that are applied. We retrospectively reviewed the medical records of all children diagnosed with VL in an 11-year period at a tertiary public hospital in the region of Athens. Demographic features, clinical information and laboratory findings were accessed. A total of 43 cases were recorded during 2005-2015. Median age of the patients was 3.7 years. Pallor (100%), fever (98%), hepatosplenomegaly (55.8%) and appetite loss (32.6%) were the most common presentations of the disease. The predominant laboratory abnormalities were anemia (100%), thrombocytopenia (90.7%), elevated inflammatory markers (86.1%) and decreased albumin/globulin (A/G) ratio (72.1%). Four patients developed secondary hemophagocytic lymphohistiocytosis syndrome, whereas in 3 others abdominal ultrasound showed splenic nodules. Bone marrow aspiration detected Leishmania parasites in 92.7% of cases and the rapid rK39 strip test indicated anti-Leishmania antibodies in 97.1% of children. In addition, all patients in whom indirect immunofluorescent antibody test was implemented had positive results. VL still affects children in our area. Fever, splenomegaly, anemia and appetite loss are the typical findings in children. Noninvasive techniques (immunofluorescent antibody test, rK39) in combination with bone marrow microscopy are useful in the diagnosis of pediatric VL.

Modelling approaches to optimize therapy for the neglected tropical disease visceral leishmaniasis in children

Modelling approaches to optimize therapy for the neglected tropical disease visceral leishmaniasis in children

Efficacy and Safety of Liposomal Amphotericin B for Visceral Leishmaniasis in Children and Adolescents at a Tertiary Care Center in Bihar, India.

Liposomal amphotericin B is being used increasingly to reduce the burden of kala-azar from the Indian subcontinent. There are studies which have evaluated efficacy and safety of liposomal amphotericin B for visceral leishmaniasis in all age groups. However, the only study that specifically addressed treatment of childhood visceral leishmaniasis did not include all ages or document renal and liver function. We, therefore, felt it was important to reassess the efficacy and safety of single dose liposomal amphotericin B in children and adolescents. A total of 100 parasitologically confirmed visceral leishmaniasis patients aged < 15 years were included in this study. Participants consisted of 65 males and 35 females. All of them had come from the endemic region of Bihar. They were administered one dose intravenous infusion of liposomal amphptericin B at 10 mg/kg body weight. Efficacy was assessed as initial and final cure at 1 and 6 months, respectively, and safety of all participants who were recruited in the study. The initial and final cure rate by per protocol analysis was 100% and 97.9%, respectively. Chills and rigors were the most commonly occurring adverse events (AEs). All the AEs were mild in intensity, and none of the patients experienced any serious AEs. No patients developed nephrotoxicity. Our finding indicates that liposomal amphotericin B at 10 mg/kg body weight is safe and effective in children. Results of our study support the use of single dose liposomal amphotericin B in all age group populations for elimination of kala-azar from the Indian subcontinent.

Short-course Regimens of Liposomal Amphotericin B for the Treatment of Mediterranean Visceral Leishmaniasis in Children: An 11-year Retrospective Study at a Tertiary Care Center.

Visceral leishmaniasis (VL) remains an important public health problem in endemic regions. Current antileishmanial agents share several limitations including potentially serious side effects and the risk of clinical failure. Aim of this study was to examine the effectiveness and safety of short-course liposomal amphotericin B (L-AmB) regimens in the treatment of childhood VL in our area. The cases of 43 VL patients (20 males; 23 females; mean age: 4.6 years) treated at a tertiary children's hospital over an 11-year period were retrospectively reviewed. Diagnosis was confirmed with identification of Leishmania spp. in bone marrow samples and/or a positive serologic test. All patients were treated with 5 different L-AmB regimens at a dose of 18-22 mg/kg. Initial response to treatment was attained in all patients (100%), while definitive cure at 6 months was achieved in 98% of patients. Adverse effects were recorded in 14 children and consisted mostly of infusion reactions and electrolyte disorders. Self-limiting nephrotoxicity was observed in 3 patients including a 12-year-old girl in whom acute kidney injury was developed. In addition, ventricular arrhythmias developed in a 13-year-old boy necessitating drug discontinuation. Although side effects were more frequent with the 2-day regimen, the difference with regard to toxicity between dosing regimens was not significant. Short-course L-AmB regimens are effective and safe for the treatment of childhood VL in our area. Our findings suggest that large L-AmB doses can possibly account for a higher rate of adverse events including nephrotoxicity.

Visceral Leishmaniasis in Children: Diagnosis, Treatment, and Prevention

AbstractLeishmaniasis is a neglected tropical parasitic disease caused by an obligate intracellular protozoan of the genus Leishmania. The disease is transmitted by the bite of infected sand flies (Phlebotomus species) and affects all ages and both genders. Nearly half of the visceral leishmaniasis (VL) cases occur in children. The clinical manifestations of pediatric leishmaniasis may be different from the adults associated with host-related factors. In this review, only the visceral form is covered. Confirmation of diagnosis is made by the parasitological, immunological, or by molecular methods. Sodium antimony gluconate (stibogluconate) has been the drug of choice for more than 60 years. However, in last three decades, its efficacy against leishmaniasis has gone significantly down especially in the Indian subcontinent where most cases of VL are seen. Therefore, other drugs, such as pentamidine-isothionate, paromomycin, amphotericin B, and miltefosine, are being used as alternative drugs for VL treatment. In the absence of an effective vaccine for VL, control measures are based on the prevention of disease transmission via vector control and community awareness. The present review focuses on the current state of the leishmaniasis, its diagnosis, treatment, and prevention with emphasis on pediatric leishmaniasis.