Visceral leishmaniasis in children

Visceral leishmaniasis in children is a long-term disease with undulating fever, hepatosplenomegaly, anemia and progressive cachexia.

There are several variants of visceral leishmaniasis: kala-azar (causative agent L. donovani donovani), Mediterranean visceral leishmaniasis (causative agent L. donovani infantum), East African (causative agent L. donovani archibaldii), etc. All variants of visceral leishmaniasis have a similar clinical picture.

Pathogenesis of visceral leishmaniasis in children

At the site of the mosquito bite, after a few days or weeks, a primary affect appears in the form of a small itchy papule, which is sometimes covered with scales or crust. From the site of the bite, leishmania are carried hematogenously throughout the body and settle in Kupffer cells, macrophages and other cells, where they multiply and cause systemic reticuloendotheliosis. Specific intoxication caused by the products of metabolism and decay of leishmania is important in the pathogenesis of leishmaniasis.

Symptoms of Visceral Leishmaniasis in Children

The incubation period lasts from 20 days to 8-12 months, most often 3-6 months. The disease progresses cyclically, three periods are distinguished: initial, the height of the disease, or anemic, and cachectic, or terminal.

• Initial period. The disease begins gradually: weakness, subfebrile body temperature, loss of appetite, sometimes enlargement of the spleen are noted. Later, the symptoms progress, the body temperature increases, the temperature curve is wavy, intermittent.
• The peak period is characterized by high short-term increases in body temperature up to 39-40 °C, severe chills and sweats. The liver and especially the spleen are always enlarged, which can occupy almost the entire abdominal cavity and reach the level of the pubis. On palpation, the liver and spleen are dense, painless. The lymph nodes are also enlarged. The condition of patients gradually worsens, signs of anemia appear. The skin becomes waxy-pale, sometimes with an earthy tint. Appetite disappears, general dystrophy progresses.
• Without treatment, the disease progresses to the final, cachectic period with severe exhaustion and edema. Nosebleeds, hemorrhages into the skin, mucous membranes, and gastrointestinal bleeding are possible. The number of erythrocytes and hemoglobin in the blood is sharply reduced, poikilocytosis, anisocytosis, anisochromia are typical, leukopenia, relative lymphocytosis, aneosinophilia, monocytosis, thrombocytopenia are characteristic; ESR is elevated. The content of blood coagulation factors is reduced.

Diagnosis of visceral leishmaniasis in children

The diagnosis is established based on the characteristic clinical picture, taking into account epidemiological data and upon detection of leishmania in bone marrow or lymph node puncture. For serological diagnostics, the RSC, latex agglutination reaction, RIF, and a biological test on white mice are used.

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Treatment of visceral leishmaniasis in children

The best effect is provided by antimonial preparations: solusurmin, meglumine antimonate (glucantime), etc. They are prescribed in age-related doses intramuscularly or intravenously; the course of treatment is 10-15, maximum 20 injections. If signs of a secondary bacterial infection appear (pneumonia, intestinal disorders, etc.), antibiotics must be prescribed. General strengthening therapy courses are carried out: blood transfusions, vitamin injections, high-calorie nutrition is prescribed.