Clinical and Pathological Features of Visceral Leishmaniasis in Pediatric Patients, Aseer Province, Southwestern Saudi Arabia

Objective: To study the clinical and pathological features of visceral leishmaniasis in pediatric age group at Aseer province, south western Saudi Arabia and to compare with other studies from Saudi Arabia.Method: This is a retrospective study carried out at Aseer Central Hospital and College of Medicine, King Khalid University (Pediatric and Pathology Departments), Abha City, Aseer province, Kingdom of Saudi Arabia, during the period from 1985 to 2007. The study included all patients who are 12 years or less and presented with symptoms and signs suggestive of visceral leishmaniasis. The clinical and pathological features (signs, symptoms, complications and hemato-pathological findings) as well as bone marrow findings were recorded.Results: A total of 123 patients were included in this study giving an average annual admission of 5.6 cases/year. Around 2/3 of the cases (64.2%) were from Tehama, while the rest of the patients (35.8%) were from Sarawat area. The disease mainly affected younger children with mean age of 2.5±2.0 years in (84.6%) of the cases. It was slightly more common in male (56.9%) compare to female (43.1%) children. Fever was evident in all of our patients (100%) with mean duration of 4.98±3.07 weeks. It is commonly associated with splenomegaly in all of them (100%) and hepatomegaly in (95.1%) of the cases. Pallor was evident in 95.1% and bleeding tendency in the form of petechiae was detected in only 16.3%. Jaundice and localized lymphadenopathy were found in a limited number of cases (4.1% and 7.3%, respectively). Hematological and laboratory findings revealed anemia in (96.7%) with mean hemoglobin concentration of 7.8±1.7g/dL; neutropenia in (73.2%), thrombocytopenia in (90.2%) and pancytopenia was evident in (66.7%). Bone Marrow aspiration was done in all cases. L. Donovani bodies were detected in bone (92.7%) and was described as sporadic in (7.3%). Histiocytic hyperplasia with hemophagocytosis (HHH) was detected in (4.9%) of the cases. Bone marrow was described as normocellular in (65.9%). Hemopoietic series showed dyserythropoiesis in (71.5%) while; myelopoiesis and megakaryopoiesis were mostly active with normal maturation in (70.7%) and (74%) respectively.Valid positivity for leishmania serology by indirect hemagglutination test was positive in only (19.6%). There was a significant difference between our findings compared with those of other studies from Saudi Arabia regarding fever, hepatomegaly and lymphadenopathy.Conclusions: Visceral leishmaniasis is a health problem among children living in Aseer Province, which mandate preventive efforts to control the disease spreading by controlling its victor. The disease should be suspected in any infant or young child presenting clinically with a triad of relatively prolonged fever, pallor and hepato-splenomegaly. Extreme vigilance and meticulous search for Leishmania donovani bodies in bone marrow smear is highly needed before declaring negative results. Leishmaniasis can have clinical presentations that might differ from one place to another, even within the same country.