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

Abstract

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.

Place of Serology in the Diagnosis of Zoonotic Leishmaniases With a Focus on Visceral Leishmaniasis Due to Leishmania infantum

“…As observed for the ELISA tests, IFAT sensitivity is lower in HIV-positive patients than in non-immunocompromised patients (Bangert et al, 2018;Freire et al, 2019). Sensitivity and specificity for VL diagnosis range from 78.8 to 100% and from 82.3 to 96.2%, respectively, in HIV-negative patients (Krepis et al, 2018;Freire et al, 2019), and from 51 to 78.4% and from 79 to 99.2%, respectively, in HIV-positive patients (Cota et al, 2012;Bangert et al, 2018). Cross-reactivity with Chagas disease, tuberculosis, toxoplasmosis, malaria, typhoid fever, or brucellosis may lead to false-positive results (Sarkari et al, 2014;Sakkas et al, 2016;Bangert et al, 2018).…”

“…All these considerations explain why there is no consensus on the best serological assay for the diagnosis of zoonotic VL. Most studies agree that rK39-based ICT represents a good solution in terms of user-friendliness, field applicability, and performance (Delgado et al, 2001;Carvalho et al, 2003;Deniau et al, 2003;de Assis et al, 2011;Maia et al, 2012;Peruhype-Magalhães et al, 2012;Cota et al, 2013;Boelaert et al, 2014;Bangert et al, 2018;Krepis et al, 2018;Freire et al, 2019). However, this assay should always be associated with at least another serological assay to increase the diagnosis sensitivity.…”

“…In home-made methods, L. infantum is the most frequently used species, whereas the use of Leishmania amazonensis is rare (Silva et al, 2005;De Almeida Silva et al, 2006;Mikaeili et al, 2007;Pedras et al, 2008). Studies are available for the following IFAT commercial assays: IFI Leishmaniose Humana (Fundação Oswaldo Cruz), Leishmania IFA IgG (Vircell), IFI-Leishmaniose Humana (Bio-Manguinhos), and Leishmania-Spot IF (bioMérieux) (Peruhype- Magalhães et al, 2012;Cota et al, 2013;Ntais et al, 2013;Varani et al, 2017;Krepis et al, 2018;Freire et al, 2019). Freire et al compared IFI-Leishmaniose Humana and Leishmania IFA IgG and found that the latter displayed higher specificity in patients without HIV infection (Freire et al, 2019).…”

“…Indeed, the assay performances can changes depending on the population (children, HIV-positive patients, immunocompetent patients) (Deniau et al, 2003;Bangert et al, 2018;Krepis et al, 2018;Freire et al, 2019). Few studies compared WB with the other serological assays because WB is mainly used for epidemiological studies to detect asymptomatic carriers and less frequently in HIV-infected patients and for CL or MCL diagnosis (Carvalho et al, 2003;Deniau et al, 2003;Cota et al, 2012;Maia et al, 2012;Pomares et al, 2012;Krepis et al, 2018). For the other assays (DAT, ELISA, IFAT, and ICT), in addition to the specific limitation of each assay, HIV infection can influence the performance of some tests (ELISA, IFAT) more than others (western blot) (Deniau et al, 2003).…”

Distinct Laboratory and Clinical Features of Secondary Hemophagocytic Lymphohistiocytosis in Pediatric Visceral Leishmaniasis

“…Cytopenia is common and hypergammaglobulinemia has been often reported. 1,7,9,10 Secondary hemophagocytic lymphohistiocytosis (sHLH) has been described in the context of VL. [9][10][11][12][13] Diagnostic criteria for HLH include clinical as well as laboratory parameters, many of which overlap with the typical VL manifestations.…”