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Visceral leishmaniasis in Libya--review of 21 cases
M I Mehabresh1, M M el-Mauhoub
1Department of Paediatrics, El-Fatah Children's Hospital, Benghazi, Libya.
Insights
Visceral leishmaniasis (VL) in Libyan children is underreported. This study highlights common symptoms and diagnostic findings in 21 pediatric cases, emphasizing the need for increased physician awareness of this public health issue.
Area of Science:
- Tropical Medicine
- Pediatrics
- Infectious Diseases
Background:
- Visceral leishmaniasis (VL) poses a significant public health challenge in Libya, yet precise prevalence data, particularly in pediatric populations, remains scarce.
- A lack of published research on VL in Libyan children necessitates a review of clinical and laboratory data.
Purpose of the Study:
- To investigate the clinical presentation, diagnostic features, and treatment outcomes of visceral leishmaniasis in children treated at El-Fatah Children's Hospital, Benghazi.
- To underscore the importance of recognizing VL in pediatric cases within the Libyan context.
Main Methods:
- Retrospective review of medical records for 21 children diagnosed with visceral leishmaniasis between March 1982 and May 1990.
- Diagnosis confirmed through clinical history, physical examination, bone marrow examination for L. donovani, and indirect haemagglutination tests.
Main Results:
- Common symptoms included fever, abdominal distension, anorexia, weight loss, hepatosplenomegaly, and pallor.
- Key laboratory findings were anemia with reticulocytosis, neutropenia, thrombocytopenia, elevated ESR, and hyperglobulinemia.
- Bone marrow positivity for L. donovani was observed in 86% of cases, and the indirect haemagglutination test was positive in all patients.
Conclusions:
- Late presentation of pediatric VL cases suggests potential underdiagnosis due to limited physician awareness in the community.
- Sodium stibogluconate treatment was effective with no major adverse effects.
- Increased awareness and prompt diagnosis are crucial for managing pediatric visceral leishmaniasis in Libya.
Abstract:
Visceral leishmaniasis is an important public health problem in Libya, but its exact prevalence is not known. Prompted by the paucity of information in the literature relevant to Libyan children, we reviewed the records of 21 children treated at El-Fatah Children's Hospital, Benghazi between March 1982 and May 1990. Visceral leishmaniasis was diagnosed on the basis of the history, physical findings and confirmatory laboratory tests including examination of bone marrow. The duration of illness before seeking medical advice ranged from 3 months to 1.5 years. The commonest presenting features were fever, abdominal distension, anorexia with weight loss, hepatosplenomegaly and pallor. The consistent laboratory findings were anaemia with reticulocytosis and normal serum iron, neutropenia, thrombocytopenia, high ESR and hyperglobulinaemia. The bone marrow was positive for L. donovani in 86% of cases and the indirect haemagglutination test was positive in all patients. Bronchopneumonia was the most common complication and responded rapidly to antibiotics. All patients were treated with sodium stibogluconate 10 mg/kg/day. There were no major side-effects or complications of drug therapy. The relative paucity of cases and their late presentation may reflect a lack of awareness of the occurrence of visceral leishmaniasis by doctors in the community.