CC BY-NC-ND 4.0 · Avicenna J Med 2020; 10(04): 223-226
DOI: 10.4103/ajm.ajm_168_20
Original Article

Pediatric visceral leishmaniasis in Tartous, Syria

Ali Othman Hamwi
College of Medicine, University of Tartous, Tartous
,
Ali Abdallatif Mohammad
College of Medicine, University of Tartous, Tartous
,
Sara Othman Hamwi
College of Medicine, University of Tartous, Tartous
,
Razan Abdallatif Mohammad
Department of Rheumatology, Tishreen Hospital, Latakia
,
Kayss Younis Shahin
Department of Paediatrics and Haematology, Tartous Children’s Hospital, Tartous, Syrian Arab Republic
› Author Affiliations

Subject Editor: Financial support and sponsorship Nil.

Abstract

Background: Visceral leishmaniasis (VL) type in Syria is Lashmania infantum, a fatal incapacitating disease, which is mostly seen in infants. Subjects and Methods: Hospital records of 19 children with VL were retrospectively reviewed. The period of the study was from June 2016 to July 2019. Results: The median age of the patients was 45.5 months. None was coinfected with human immunodeficiency virus or known to be immunocompromised. Pallor and anemia were observed in all cases, fever in 13 (68.42%), splenomegaly in 18 (94.7%), hepatomegaly in 11 (57.9%), thrombocytopenia in 15 (78.95%), and leukopenia in nine (47.4%). A bone marrow aspirate was obtained and Leishmania amastigotes were detected in all patients. All patients were initially treated with meglumine antimonate; one child did not respond and was treated with lipid formulations of amphotericin B. Conclusions: Presentation of VL in the pediatric age group is characterized by pallor, fever, splenomegaly, and hepatomegaly. Hematological and biochemical indices are typical with cytopenias. In all cases, microscopic examination provided a positive diagnosis. Despite recent reports on decreased responses to antimonial drugs of patients with Mediterranean VL, meglumine antimonate treatment appears to be still highly effective in Syria.



Publication History

Article published online:
04 August 2021

© 2020. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Diagnosis and Treatment of Leishmaniasis. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). 2016 Available from: http://cid.oxfordjournals.org/content/early/2016/11/03/cid.ciw670.full.pdf+html. [Last accessed on 2016 Nov 16]
  • 2 WHO/Department of Control of Neglected Tropical Diseases. Global leishmaniasis update, 2006–2015: A turning point in leishmaniasis surveillance. Wkly Epidemiol Rec 2017; 92: 557
  • 3 Pratlong F, Lami P, Ravel C, Balard Y, Dereure J, Serres G. et al. Geographical distribution and epidemiological features of old world leishmania infantum and leishmania donovani foci, based on the isoenzyme analysis of 2277 strains. Parasitology 2013; 140: 423-34
  • 4 Mniouil M, Fellah H, Amarir F, Et-touys A, Bekhti Kh, Adlaoui El B. et al. Epidemiological characteristics of visceral leishmaniasis in Morocco (1990–2014): An update. Acta Tropica 2017; 170: 169-77
  • 5 Hayani K, Dandashli A, Weisshaar E. Cutaneous leishmaniasis in Syria clinical features, current status and the effects of war. Acta Derm Venereol 2015; 96: 62-6
  • 6 Haddad N, Saliba H, Altawil A, Villinsky J, Al-Nahhas S. Cutaneous leishmaniasis in the central provinces of Hama and edlib in Syria: Vector identification and parasite typing. Parasit Vectors 2015; 8: 524
  • 7 Youssef A, Harfouch R, El Zein S, Alshehabi Z, Shaaban R, Kanj S. Visceral and cutaneous leishmaniasis in a city in Syria and the effects of the Syrian conflict. Amj J Trop Med Hyg 2019; 101: 108-12
  • 8 El Hajj R, El Hajj H, Khalifeh I. Fatal visceral leishmaniasis caused by leishmania infantum, Lebanon. Emerg Infect Dis 2018; 24: 906-7
  • 9 Petrela R, Kuneshka L, Foto E, Zavalani F, Gradoni L. Pediatric visceral leishmaniasis in Albania: A retrospective analysis of 1,210 consecutive hospitalized patients (1995–2009). PLoS Negl Trop Dis 2010; 4: e814
  • 10 Magill A. Leishmania species. Chapter 277. In: Bennett JE, Dolin R, Blaser MJ. editors Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2015: 3091-107
  • 11 Jeronimo S, de Queiroz Sousa A, Pearson R. Leishmaniasis. In: Guerrant RL, Walker DH, Peter F. editors Tropical Infectious Diseases: Principles, Pathogens, and Practice. 2nd ed. Philadelphia, PA: Saunders Publishing; 2006: 1095-113
  • 12 Stark CG. Leishmaniasis. February 18, 2020. Available from: https://emedicine.medscape.com/article/220298-overview?src=android&devicetype=android&osversion=9&appversion=6.1.1&src=medscapeapp-android&ref=share. [Last accessed on 2020 Apr 14]
  • 13 Berhe N, Hailu A, Abraham Y, Tadesse Y, Breivik K, Abebe Y. Inter-current and nosocomial infections among visceral leishmaniasis patients in ethiopia: An observational study. Acta Trop 2001; 80: 87-95
  • 14 World Health Organization. Leishmaniasis in Syrian Arab Republic. 2016 [cited 2018 Mar 4]. Available from: http://www.who.int/leishmaniasis/resources/Leishmaniasis_cp_Syria_2014_updated.pdf. [Last accessed on 2020 May 5]
  • 15 Shaikh N, Hoberman A. Urinary tract infections in infants and children older than one month: Clinical features and diagnosis. 2020 Available from: https://www.uptodate.com/contents/urinary-tract-infectionsin-infants-and-children-older-than-one-month-clinical-features-anddiagnosis. [Last accessed on 2020 May 8]
  • 16 Bloomfield P, Hodson EM, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev Jan 25 2005;(1):CD003772
  • 17 Totan M, Dagdemir A, Muslu A, Albayrak D. Visceral childhood leishmaniasis in turkey. Acta Paediatr 2002; 91: 62-4
  • 18 Das VN, Siddiqui NA, Pandey K, Singh VP, Topno RK, Singh D. et al. A controlled, randomized nonblinded clinical trial to assess the efficacy of amphotericin B deoxycholate as compared to pentamidine for the treatment of antimony unresponsive visceral leishmaniasis cases in Bihar, India. Ther Clin Risk Manag 2009; 5: 117-24
  • 19 Grech V, Mizzi J, Mangion M, Vella C. Visceral leishmaniasis in Malta: An 18 year paediatric, population based study. Arch Dis Child 2000; 82: 381-5