[Infantile visceral Leishmaniasis: epidemiological, clinical and biological characteristics. About 93 case reports in the children hospital of Rabat]

Abstract

Introduction: Infantile visceral leishmaniasis (LVI) is a problem of public health in Morocco. This parasitosis rages to the state of endemic and touches the infants.

Objectives: The goal of this survey is to draw up epidemiological, clinical and biologic profile of LVI in children hospitalized in the Children's Hospital of Rabat, and to prove the contribution of serology in diagnosis of this illness.

Material and methods: This retrospective study concerned all LVI cases gathered in the HER during 5 years (from 1997 to 2001). For every patient included in this study, the authors collected geographical origin, age, sex, clinical data (splenomegaly, fever, hepatomegaly, paleness), and biologic data (numeration formulates red chalk, speed of sedimentation, protein in blood and electrophoresis of the proteins). The myelogram results were also exploited as well as results of serology when they were realized.

Results: Ninety-three LVI cases were listed with an age average of 3.5+/-3 years, and a sex ratio of 1.82 (p=0.032). Patients coming from farming surroundings or semi-urban were more numerous than those from cities: 85.5% versus 14.5% (p<0.0001). Most of the patients suffered from splenomegaly, fever and paleness; anaemia was almost constant. In case of hyperprotidemy (43.5%; n=27), the albumin-globulin report was always lower than 1.2. Indirect immunofluorescence was practised among 39 patients with a positive response in 84.6% of the cases. Forty patients whose serums were analyzed by indirect hemagglutination (HAI) had all a myelogram revealing the presence of protozoon, but only 57% of them showed a positive reaction in HAI.

Conclusions: These results confirm that the LVI touches children coming from underprivileged surroundings. The triad, splenomegaly, paleness and fever, is a good element of diagnostic orientation, whereas parasite revelation in bone marrow remains the best way to establish the diagnosis of this illness.