Visceral leishmaniasis: clinical and laboratorial aspects

Abstract

Objective: to compare the clinical and laboratorial data before and after the treatment of patients with visceral leishmaniasis admitted to a pediatric hospital in a nonendemic area, highlighting the importance of recognizing visceral leishmaniasis in pediatric patients.Methods: clinical, laboratorial and treatment data of 78 patients with visceral leishmaniasis were evaluated from 1981 to 1992. We analyzed the average level of hemoglobin, leukocyte, neutrophil, platelet, albumin, gammaglobulin, class and subclass of immunoglobulin, size of the liver and spleen during the pre-and posttreatment using the paired t test.Results: we included 78 patients with visceral leishmaniasis, 44 males, with age ranging from 8 months to 13.5 years. Sixty-one patients were from Bahia. Fever and splenomegaly were present in 96.1% and 100% of the cases, respectively. The parasitological diagnosis was obtained in 74/78 patients: 67 patients through smear and/or culture of bone marrow (85.7%), five through liver biopsy and two through spleen puncture. The hematological findings and serum albumin presented significant improvement at the end of treatment (P<0.001), differently from serum gammaglobulin levels (P=0.087). There was predominance of IgG1 subclass, with two patients presenting low levels of IgG2. Initial treatment used antimoniate in 67 cases and amphotericin B in five. Eleven patients (15.7%) needed a second treatment, and were considered cured after it. There was significant improvement in the liver and spleen size at the end of the treatment (P<0.001). One patient presented spontaneous remission and five died due to bleeding.Conclusions: in order to obtain accurate diagnosis and treatment, especially regarding health services of areas with low-incidence of visceral leishmaniasis, the diagnosis of patients with fever and visceromegaly, who come from endemic areas, should include visceral leishmaniasis.J Pediatr (Rio J) 2002; 78 (2): 120-7: visceral leishmaniasis, kala-azar, infancy, diagnosis, treatment. ResumoObjetivo: comparar os dados clínicos e laboratoriais no pré e pós-tratamento de pacientes portadores de leishmaniose visceral (LV), admitidos em hospital pediátrico localizado em área não-endêmica, destacando a importância do reconhecimento da LV na faixa etária pediátrica.Métodos: avaliação dos dados clínicos, laboratoriais e de tratamento de pacientes portadores de LV no período compreendido entre 1981 e 1992, comparando-se os valores médios de hemoglobina, leucócitos, neutrófilos, plaquetas, albumina, gamaglobulina, classes e subclasses de imunoglobulinas, tamanho do fígado e baço antes e após o tratamento, utilizando-se o teste "t" para amostras pareadas.Resultados: foram incluídos 78 pacientes, com idade variando entre 8 meses e 13,5 anos, sendo 44 casos do sexo masculino e 61 provenientes da Bahia. Febre e esplenomegalia estavam presentes em 96,1% e 100% dos casos, respectivamente. O diagnóstico parasitológico foi obtido em 74/78 pacientes, com positividade pelo mielograma e/ou mielocultura em 67 casos...

Clinical presentation and renal evaluation of human visceral leishmaniasis (kala-azar): a retrospective study of 57 patients in Brazil

“…The main clinical symptoms and signs presented at the initial evaluation were: fever (97%), splenomegaly (96.4%), weight loss (95.5%), pallor (93.6%), cough (89.7%), hepatomegaly (87.2%), asthenia (83.3%), anorexia (82.9%) and vomiting (73.9%) (Figure 1). year in Brazil [5,6,9,10]. All over the world, about 200 million people are at risk [4].…”

“…The main clinical manifestations among our patients were fever, splenomegaly, weight loss, pallor, cough, hepatomegaly, asthenia, anorexia and vomiting. In recent Brazilian studies of 78 to 530 patients with visceral leishmaniasis, the main signs and symptoms presented were hepatomegaly (77%-100%), pallor (98%), fever (94%-96%), splenomegaly (77%-100%), lymphadenopathy (86%), abdominal volume increase (72%-82%), eyelash growth (74%), dry hair (73%), weight loss (69%-71%), anemia (69%), asthenia (59%-66%), anorexia (38%-61%), cough (30%), hemorrhage manifestations (10%-28%), nausea/vomiting (27%), myalgia (19%), headache (19%), diarrhea (19%), edema (14%-17%) dry skin (12%) and jaundice (6%) [9,12,13]. This demonstrates the large spectrum of clinical manifestations that can be seen in visceral leishmaniasis.…”

Visceral leishmaniasis: Clinical and demographic features in an African population

“…This male gender preponderance, particularly among children, has also been reported from South America. 25 However; the underlying aetiology of this VL feature is not fully understood. A study from Brazil has suggested a hormonal factor to be linked with this phenomenon.…”

Geographical Distribution of Visceral Leishmaniasis Among Children in Dhamar Governorate, Yemen

“…The prevalence of VL in pediatric population is high due to the higher susceptibility to infections and the immune-depressed state found in this population [6]. The majority of pediatric patients present with fever, anemia, hepatosplenomegaly, weight loss, haemorrhage, lymphadenopathy and less frequently dry cough and diarrhea [7].…”