Clinical aspects of paediatric visceral leishmaniasis in North‐west Ethiopia

Abstract

Abstractobjective Visceral leishmaniasis (VL) in north-west Ethiopia is causing an overwhelming case load among adult migrant workers that masked the disease burden in children. This study describes the clinical profile and explores comorbidities in paediatric VL patients.methods A prospective study at two hospitals in this region (Gondar and Humera) was conducted in a year period, 2011-2012. The clinical manifestations and comorbidities such as malnutrition, intestinal parasitosis and vitamin D deficiency and HIV infection were assessed, and treatment outcomes noted.results A total of 122 children with VL were detected during the study period with median age of 8.5 years (IQR 5-12 years); 23% were under 5 years. Eighty-five (69.7%) cases were male. The clinical manifestations were similar to the adult patients. High rates of malnutrition, intestinal parasitosis (47.5%) and hypovitaminosis D (56.4%) were detected. The proportion of stunting and wasting was 63% and 22.2% in children aged under five years, and 50.5% and 75.9% in 5-year and older children, respectively, using WHO standard growth curves. Only one child had HIV infection. In 95% of the cases, sodium stibogluconate (20 mg/kg/day for 30 days) was used for treatment. The treatment success rate at end of therapy was 98.3%, but the definitive outcome at 6 months could not be determined because of a high loss to follow-up (80.2%).conclusion While HIV co-infection was rare, malnutrition, intestinal parasitosis and vitamin D deficiency were frequent indicating the need for further research on their role in the pathophysiology. Meanwhile, systematic assessment and management of malnutrition and intestinal parasitosis in VL programmes is recommended.

Prevalence estimates of human immunodeficiency virus (HIV) infection among visceral leishmaniasis infected people in Northwest Ethiopia: a systematic review and meta-analysis

“…Sensitivity analysis was carried out by excluding each study step-by-step from the metaanalysis and comparing point prevalence estimate before and after removing a single study. Accordingly, removing a single study did not alter the pooled prevalence estimate considerably, with sensitivity analysis ranging from 20.88% (when [26] was removed) and 24.86% (when [25] was removed) (Fig. 4).…”

“…Though the burden of HIV infection is diminishing in the general Ethiopian population, the prevalence of HIV infection in VL patient is considerably high [23,24]. According to various study reports on co-occurrence of HIV and VL in Ethiopia, the prevalence is considerably inconsistent and heterogeneous, ranging from 0.82% [25] to 67.5% [26]. Besides, to the best of our knowledge, there was no previous study that estimates the pooled prevalence of HIV coinfection in people infected with VL in Ethiopia; hence, this systematic review and meta-analysis was carried out.…”

Disease severity in patients with visceral leishmaniasis is not altered by co-infection with intestinal parasites

“…Infection with Leishmania parasites can be asymptomatic or can manifest as a progressive disease. VL is characterised by hepatosplenomegaly, fever, weight loss, hyperglobulinemia and pancytopenia [ 6 ]; if left untreated, it is almost always fatal. In Ethiopia, VL is caused by L .…”

“…donovani and it is one of the most significant vector-borne diseases; Ethiopia has the second largest number of VL cases in sub-Saharan Africa with an estimated annual burden of 4500 to 5000 new cases. VL is worsened by malnutrition and HIV co-infection, and it has been suggested that intestinal parasitic infections might also impact on disease severity by modulating cell-mediated immunity and by worsening malnutrition [ 6 ]. Helminth infections are characterised by a strong Th2 response [ 7 ] and it has been suggested that this might suppress a protective Th1 response in VL patients and therefore contribute to the strong immunosuppression characteristic of these patients [ 8 ].…”

Agricultural Sector and HIV/AIDS Pandemic in Africa: The Economic Retrogression Model

“…The increasing incidence and spread of HIV/AIDS epidemic has created drastic changes in the society and the economy of nations. Past studies have shown that HIV/AIDS affects people in their productive age groups (15 -49 years old), resulting in a loss of agricultural labour [6]- [9]. In addition, caregivers who have to give up working in the fields in order to take care of the sick deprived labour for agricultural activities [10] [11].…”