Visceral leishmaniasis in 13 pediatric patients in Turkey: treatment experience

Visceral leishmaniasis (VL) is a life-threatening systemic infection caused by protozoa of the genus Leishmania and transmitted by phlebotomine sandflies. Leishmaniases are widespread in most countries in the Mediterranean basin, including Turkey. Leishmania infantum is responsible for VL in Turkey. We previously reported 19 children with VL who were diagnosed during the period of January 2000 to December 2003. In this study, 13 consecutive cases of VL admitted to our hospital between December 2003 and January 2008 were analysed retrospectively. Fever, splenomegaly and hepatomegaly were most common findings in physical examination while anemia, elevated erythrocyte sedimentation rate and C-reactive protein were the most common laboratory findings. Bone marrow aspirate was obtained in all cases and Leishmania amastigotes were detected in 9 of them (69.2%). Leishmania antibodies by the immunofluorescent antibody test were positive in all cases. All of the patients were treated initially with meglumine antimonate. Treatment failure occurred in two children, who were subsequently cured with liposomal amphotericin B. One additional child was treated with liposomal amphotericin B because of the side effects of meglumine antimonate. All the children were finally cured. Meglumine antimonate still seems to be the first choice in the treatment of pediatric VL in Turkey.