Visceral leishmaniasis in children

Visceral leishmaniasis in children is a long-lasting disease with wave-like fever, hepatosplenomegaly, anemia and progressive cachexia.

There are several variants of visceral leishmaniasis: kala-azar (causative agent of L. Donovani donovani), Mediterranean visceral leishmaniasis (causative agent of 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 occurs in the form of a small itchy papule, which is sometimes covered with a scaly or crust. From the place of the bite of leishmania hematogenously spread throughout the body and settle in Kupffer cells, macrophages and other cells, where they multiply and cause systemic reticuloendotheliosis. In the pathogenesis of leishmaniasis, specific intoxication is important, due to the products of metabolism and decay of leishmania.

Symptoms of visceral leishmaniasis in children

The incubation period lasts from 20 days to 8-12 months, more often is 3-6 months. The disease proceeds cyclically, distinguishing three periods: the initial period, the height of the disease, or anemic, and cachectic, or terminal.

• The initial period. The disease begins gradually: note weakness, subfebrile body temperature, a decrease in appetite, sometimes an increase in spleen. Later the symptoms progress, the body temperature increases, the temperature curve is undulating, intermittent.
• The peak period is characterized by high short-term body temperature rises to 39-40 ° C, strong 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. With palpation, the liver and spleen are dense, painless. The lymph nodes are also enlarged. The condition of patients gradually deteriorates, signs of anemia appear. The skin becomes waxy-pale, sometimes with an earthy tinge. Appetite disappears, general dystrophy progresses.
• Without treatment, the disease passes into the final, cachectic period with severe depletion and edema. Possible nasal bleeding, hemorrhages in the skin, mucous membranes, as well as gastrointestinal bleeding. In the blood, the number of erythrocytes, hemoglobin, typical of poikilocytosis, anisocytosis, anisochromia is sharply reduced, leukopenia, relative lymphocytosis, aneosinophilia, monocytosis, thrombocytopenia are characteristic; ESR is enhanced. The content of coagulation factors is reduced.

Diagnosis of visceral leishmaniasis in children

The diagnosis is established on the basis of a characteristic clinical picture, taking into account epidemic data and when leishmania is detected in the punctate of the bone marrow or lymph node. For serological diagnosis, RBC, latex agglutination reaction, RIF, as well as biological test on white mice are used.

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Treatment of visceral leishmaniasis in children

The best effect is made by antimony preparations: solyusurmin, meglumina antimonate (glucantimite), etc. They are prescribed in age doses intramuscularly or intravenously; for a course of treatment of 10-15, a maximum of 20 injections. When signs of a secondary bacterial infection appear (pneumonia, intestinal disorders, etc.), antibiotics should be prescribed. Conduct courses of restorative therapy: blood transfusions, injections of vitamins, prescribe a high-calorie diet.