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Revista del Instituto de Medicina Tropical

Print version ISSN 1996-3696

Abstract

APODACA, Silvio et al. Visceral Leishmaniasis in Immunocompetent Children. Rev. Inst. Med. Trop. [online]. 2014, vol.9, n.1, pp.27-35. ISSN 1996-3696.

Background. Visceral leishmaniasis (VL) was an uncommon pediatric diseases in Paraguay until the end of the last century. However, after the 2000 year, the disease emerged among both children and adults. Objective. To show the epidemiological characteristics, clinical manifestations and outcome of VL in immunocompetent children. Material and methods. Retrospective case analysis of patients (pts)<15 years with VL hospitalized in our institution in the past 7 years. All cases were confirmed by serology test using Rk39 antigen and/or by observation of amastigotes in bone marrow smear (BMS). The clinicopathological features, with emphasis in complications, as well as the diagnostic role of BMS compared to serology were evaluated. Results. From 2003 to april 2010, a total of 31 cases of VL were diagnosed and treated at the IMT. The mean age of the pts was 41±41 months and none was HIV positive. Fever (mean duration before diagnostic: 35 days), splenomegaly and hepatomegaly were observed in 97%, 100% and 97% of the pts, respectively. Among the laboratory abnormalities, increased levels of liver enzymes (>3 times), anemia, leucopenia and thrombocytopenia were present in 29%, 93%, 68% and 71% of the pts, respectively, and 15 (48%) were pancytopenic. 23/31 pts (74%) showed during the hospitalization one or more infectious complications (pneumonia=12, ITU=8, others=5), and 4/31 pts (13%) exhibited clinical and laboratorial feature of hemophagocytic syndrome (HPS). Amastigotes were observed in BMS in 94% (29/31) of the pts and the serology was positive (except one) in all cases. 29 pts were treated at admission with antimonial compounds, and 2 with amphotericin B (cases with HPS). In adition, 2 pts required switch to amphotericin B. Relapse was observed in one patients (4%) and no patient passed away. Conclusions. VL in immunocompetent children is being observed with increased frequency in Paraguay, and have a good prognosis. Althoug the majority of the pts will respond to antimonial compounds, amphoterin B could be necessary in unresponsive pts or with HPS.

Keywords : hemophagocytic syndrome; amphotericin B; splenomegaly; hepatomegaly.

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