Epidemiological and clinical features of visceral leishmaniasis in children in Alicante Province, Spain

Abstract

Background: Visceral leishmaniasis (VL) is endemic to the Mediterranean basin. In children, VL often presents with non-specific symptoms and can be life-threatening without proper treatment.

Aim: To describe the epidemiological and clinical features of pediatric VL in children in Alicante, Spain.

Methods: The study included all paediatric (<15 years) cases admitted to three hospitals in the province of Alicante from May 1992 to May 2015 with diagnosis of VL (detection was either by anti-Leishmania antibodies in serology or Leishmania in blood and/or bone marrow aspirates).

Results: There were 38 cases of pediatric VL (18 aged <24 months, 15 aged 24–59 months and 5 aged ≥5 years). The main symptoms were fever (97.4%), followed by pallor (75.0%) and loss of appetite (46.4%). Eighty-seven per cent of patients were anaemic (haemoglobin < 9 g/dL), 73.7% had neutropenia and 68.4% had thrombocytopenia. Before 2004, 92.3% of patients were treated with meglumine antimoniate (MA) and 7.7% with liposomal amphotericin B (LAmB); after 2004, 84% were treated with LAmB and just one (16%) with MA (p < 0.001). LAmB performed better than MA in terms of mean treatment length (7.4 days vs 25.9 days, p < 0.001), time to becoming afebrile (1.7 vs 13.7 days, p < 0.001), and length of hospital stay (10.9 vs 19.4 days, p = 0.001).

Conclusion: Paediatric VL in Alicante mainly affects children under five. Children aged ≤24 months present with a lower haemoglobin and white blood cell count. Treatment with LAmB reduces treatment length, time to becoming afebrile and length of hospital stay.

Keywords:

• Visceral leishmaniasis
• paediatrics
• child
• epidemiology
• signs and symptoms
• liposomal amphotericin B
• Spain

Acknowledgments

The authors thank all the paediatric staff of the General University Hospital of Alicante, the University Clinical Hospital of San Juan de Alicante and Hospital Marina Baixa for making this study possible. We thank Ms. Meggan Harris for excellent technical assistance.