Pediatric leishmaniasis

Mediterranean-Central Asian visceral leishmaniasis (synonyms: childhood leishmaniasis, childhood kala-azar).

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Epidemiology of childhood leishmaniasis

Childhood leishmaniasis is a zoonotic disease. There are 3 types of foci of Mediterranean-Central Asian leishmaniasis:

1. natural foci in which the pathogen circulates among wild animals (jackals, foxes, rodents, including gophers, etc.), which are reservoirs and sources of invasion in these foci;
2. rural foci, in which the pathogen circulates primarily among dogs - the main sources of invasion, as well as wild animals. Under certain conditions, wild animals in such foci can serve as a significant reservoir and, therefore, a relevant source of infection for the population;
3. urban (synanthropic) foci, in which the main source of invasion is dogs, but the pathogen is also found in synanthropic rats.

Overall, dogs from rural and urban foci of leishmaniasis represent the most significant source of L. infantum infection in humans.

Leishmania is carried by various types of mosquitoes: Ph. ariasi. Ph. perniciosus, Ph. Smirnovi. Mostly children aged 1 to 5 years in North Africa and Southwest Asia are affected, as well as children aged 5 to 9 years in East Africa. In China, Central Asia and Southern Europe, all age groups are affected.

The incidence is sporadic, with small epidemic outbreaks possible in cities. The infection season is summer, and the incidence season is autumn of the same year or spring of the following year. Foci are located between 45° N and 15° S, and are registered in Mediterranean countries, northwestern regions of China, and the Middle East. Sporadic cases are detected in the states of Central Asia and Transcaucasia.

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What causes childhood leishmaniasis?

Infantile leishmaniasis is caused by L. infantum.

Pathogenesis and pathological-anatomical picture of childhood leishmaniasis

The pathogenesis of childhood leishmaniasis does not differ significantly from that of Indian leishmaniasis; a special feature is the development of a primary affect at the site of the mosquito bite in a number of patients.

Symptoms of childhood leishmaniasis

The incubation period of childhood leishmaniasis lasts from 20 days to 3-5 months. At the site of the bite in children aged 1-1.5 years, less often in older children and adults, a primary affect appears in the form of a papule, sometimes covered with scales. It is important to correctly assess this symptom, since it appears long before the general manifestations of the disease.

Symptoms of childhood leishmaniasis are not fundamentally different from those of Indian leishmaniasis: a picture of systemic parasitic reticuloendotheliosis develops. The most significant features of Mediterranean-Central Asian visceral leishmaniasis are the absence of cutaneous leishmaniasis and the involvement of lymph nodes in the pathological process, both peripheral and mesenteric, peribronchial, etc. As a result, in the clinical picture of Mediterranean-Central Asian visceral leishmaniasis, manifestations of peripheral lymphadenitis are possible, less often - mesadenitis. Enlargement of the peritracheal and peribronchial nodes can provoke paroxysmal cough. Pneumonia caused by secondary infection often develops.

The disease childhood leishmaniasis can occur in acute, subacute and chronic forms.

The acute form occurs mainly in young children and without treatment or with delayed therapy ends in death.

The subacute form is severe, often with the development of complications. Without specific treatment of childhood leishmaniasis, the patient may die in 5-6 months.

The chronic form of childhood leishmaniasis occurs mainly in older children, less often in adults. It is characterized by a milder course and, with timely treatment, ends in recovery.

Diagnosis of childhood leishmaniasis

Diagnosis of childhood leishmaniasis is based on the epidemiological history (stay in endemic areas) and symptoms. Laboratory confirmation of the diagnosis is similar to Indian visceral leishmaniasis. In 75% of such patients, leishmania is detected in the blood, in 88% - in the skin and almost always - in the pleural fluid.

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Treatment of childhood leishmaniasis

Treatment for childhood leishmaniasis is the same as for Indian visceral leishmaniasis.

Childhood leishmaniasis usually has a favorable prognosis, with the exception of mixed infection of visceral leishmaniasis and HIV.