Pediatric visceral leishmaniasis in Albania

Abstract

Objective: Visceral leishmaniasis (VL) in children is endemic in southern Europe but has not been previously reported from Albania. This prospective study reports the clinical and laboratory findings in 50 children with visceral leishmaniasis, the value of a direct agglutination test (DAT), and the result of treatment with meglumine antimonate.

Materials and methods: Sera obtained from 50 children with VL confirmed by bone marrow examination, 40 household contacts, and 30 hospitalized children with other infections were examined using DAT.

Results: Clinical features included fever (100%), hepatosplenomegaly (100%), pallor (100%), weight loss (98%), vomiting (68%), diarrhea (32%), and bleeding disorders (8%). Laboratory findings were anemia (94%), neutropenia (85%), hypergammaglobulinemia (70%), and thrombocytopenia (22%). Thirty children who developed secondary bacterial infections had significantly lower hemoglobin and neutrophil counts (P<0.0001). Direct agglutination test had a sensitivity of 98%, a specificity of 100%, and a positive predictive value of 100%. One child with severe generalized bleeding died within 48 hours of admission before receiving treatment.

Conclusion: The direct agglutination test was highly valuable in diagnosis of VL in this series. Meglumine antimonate was an effective therapeutic agent. Post-treatment bone marrow examination confirmed recovery in all patients. There were no relapses of VL during one-year follow up.