[Childhood visceral leishmaniasis in Provence]

Fifty-nine cases of children with visceral leishmaniasis were retrospectively studied in a survey of hospital records in the Provence region of South France concerning a 15 years period (1981 to 1997). None of the children was immunocompromised. The mean age was 31 months but 10 children were younger than one year. The male/female ratio was 0.73. Fever and splenomegaly were present in 90% and 100% of the cases respectively. Anemia, leukopenia and thrombocytopenia were commonly observed. A medullogram was systematically performed, but direct microscopic examination of the bone marrow identified Leishmania in only 78% of the cases. In these patients, specific serology and genomic amplification using polymerase chain reaction were useful tools for the diagnosis. All patients were initially treated with meglumine antimonate (Glucantime). Twenty-six (44%) receiving the drug experienced at least one adverse event during treatment. Treatment failure occurred in 6 children (10%), who were subsequently cured with liposomal amphotericin B. Three additional children were treated with liposomal amphotericin B. All the children were finally cured and no death was observed. Pediatric visceral leishmaniasis is an uncommon disease in the endemic area of South France. Resistance to antimonial therapy occurs in children as well as in adults. Liposomal amphotericin B appears as an effective therapy for visceral leishmaniasis in children and could be used as a first-line treatment.