Visceral leishmaniasis in children: a review

Leishmaniasis is distributed worldwide and 13 million people are estimated to be infected, with about 1.8 million new cases each year. Approximately 50% of these patients are children. It should be suspected in children who present with specific manifestations and the diagnosis should be established, mainly by the demonstration of leishmania in tissue specimens. Molecular techniques could soon change this situation considering the promise they have shown in the diagnosis of other infectious diseases. Several advances in the treatment of visceral leishmaniasis have been accomplished during the past few years. All antileishmanial drugs are toxic and most have to be used parenterally for prolonged period. The therapy has been further complicated by large number of infected children and declining effectiveness of pentavalent antimonial compounds. Although the lipid formulations of amphotericin B are an important advance in therapy, their high cost precludes their use. Miltefosine, a phosphocholine analogue originally developed as anti-malignant drug, has been found to be highly active against leishmania in vitro and in animal model. The aim of this review is to evidence the recent advances in diagnosis and treatment of visceral leishmaniasis.