بررسي ليشمانيوز احشايي كودكان در مركز پزشكي كودكان تبريز

Study of Pediatric Visceral Leishmaniasis in Childrenʹs Medical Center ofTabriz

Background and Objectives: Despite the advances made in pediatric visceral leishmaniasis in recent years, still its treatment and some features, particularly in our country requires to be evaluated. The purpose of this study was to describe the characteristics of pediatric visceral leishmaniasis in Azarbaijan Province and to evaluate the new scheme of therapy. Materials and Method?: Hospital records of 50 children with visceral leishmaniasis were retrospectively reviewed for epidemiologic, clinical, biological and therapeutic features. The period of the study was from year 1994 to 1999. Results: Most of the children were living or had previously dwelled in Moghan, Kalaibar and Ahar (66%). The age of patients ranged from 6 months to 12 years. When admitted to the hospital, 11(22%) children were found younger than 1 year. The male: female ratio was 1:17. Fever and splenomegaly were presented in 100 and 98% children respectively. Anemia, leukopenia and thrombocytopenia were commonly observed in patients. Erythrocyte sedimentation rate (ESR) was elevated in all patients, and in 15 (30%) cases ESR was above 100 mm/h. A bone marrow aspirate was obtained in all patients, and direct microscopic examination identified organism in 41(82%) cases. Serology was done by direct agglutination test (DAT) in 32(64%) children. It was positive in 30 children and negative in two. All patients were initially treated with meglumine antimonate (Glucantime), Treatment failure occurred in two children (4%). One of them was subsequently cured with second course of glucantime, and the other was cured with amphotericin B. All children were finally cured and no fatality was observed. Conclusion: Our study suggests that antimony medication is effective therapy for visceral leishmaniasis in children of Azerbaijan, and amphotericin B and its lipid formulation may be useful in case of antimony failure.