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Hemophagocytic Syndrome in Children With Visceral Leishmaniasis
Elizabeth F Daher1, Laio L L Lima, Ana Patrícia F Vieira
1From the *Department of Internal Medicine, School of Medicine, Post-Graduation Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil; †Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil; ‡Division of Pediatric Nephrology, Albert Sabin Pediatric Hospital, Fortaleza, Ceará, Brazil; and §School of Medicine, Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil.
Insights
Hemophagocytic lymphohistiocytosis (HLH) is a significant complication in children with visceral leishmaniasis (VL). This study highlights common symptoms, lab findings, and the frequent occurrence of mild acute kidney injury (AKI) in these patients, with a notably low mortality rate.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Nephrology
Background:
- Visceral leishmaniasis (VL) can lead to severe complications, including hemophagocytic lymphohistiocytosis (HLH).
- Understanding the clinical and laboratory spectrum of HLH in pediatric VL cases is crucial for timely diagnosis and management.
- This study focuses on HLH in children diagnosed with VL in Northeast Brazil.
Purpose of the Study:
- To describe the demographical, clinical, and laboratory features of HLH in children diagnosed with visceral leishmaniasis.
- To investigate the incidence and characteristics of acute kidney injury (AKI) in pediatric VL patients with HLH.
- To assess the outcomes and mortality associated with HLH in this patient population.
Main Methods:
- A retrospective cohort study was conducted on children diagnosed with both HLH and VL.
- Data collected included clinical signs, symptoms, and laboratory parameters at admission and during hospitalization.
- Acute kidney injury (AKI) was defined using the pediatric Risk, Injury, Failure, Loss, End-stage kidney disease (pRIFLE) criteria.
Main Results:
- Out of 127 VL patients, 35 (27.6%) were diagnosed with HLH. The mean age was 4.2 years, and 62.9% were male.
- Common presentations included fever (100%), splenomegaly (94.2%), and hepatomegaly (60%). Key laboratory findings indicated pancytopenia and elevated ferritin levels.
- Acute kidney injury (AKI) was present in 45.7% of cases, predominantly mild forms (93.75% 'risk' stage). The AKI group showed significantly lower platelet counts.
Conclusions:
- HLH is a frequent complication of visceral leishmaniasis in children.
- Clinical and laboratory findings in pediatric VL-associated HLH are consistent with HLH pathophysiology.
- Mild forms of AKI are common in pediatric HLH patients with VL, but overall mortality was low despite disease severity.
Background:
Hemophagocytic lymphohistiocytosis (HLH) is a serious complication of visceral leishmaniasis (VL). The aim of this study is to describe demographical, clinical and laboratory features of HLH in children with VL.
Methods:
This is a retrospective cohort of children with HLH and VL admitted to a tertiary hospital in Northeast, Brazil, from January 2012 to April 2014. Clinical and laboratory data at admission and during hospital stay were reviewed. Acute kidney injury (AKI) was defined according to the pediatric Risk, Injury, Failure, Loss, End-stage kidney disease criteria.
Results:
A total 127 VL children were admitted, and 35 children had diagnosis of HLH. Mean age was 4.2 ± 4.3 years, with 62.9% males. Mean hospital stay was 29 ± 12 days. Main signs and symptoms were fever (100%), splenomegaly (94.2%) and hepatomegaly (60%). Laboratory findings showed pancytopenia, albumin 3.03 ± 0.77 g/dL, fibrinogen 236.1 ± 117.2 mg/dL, total calcium 8.2 ± 1.2 mEq/L, lactate dehydrogenase 1804 ± 1019 mg/dL, alkaline phosphatase 1275.4 ± 2160.5 IU/L, total bilirubin 1.9 ± 2.4 mg/dL, direct bilirubin 0.67 ± 1.02 mg/dL, indirect bilirubin 1.2 ± 2.2 mg/dL, aspartate aminotransferase 140.0 ± 145.3 IU/L, alanine aminotransferase 71.4 ± 81.1 IU/L, ferritin 4296.5 ± 8028.8 ng/dL and triglycerides 333 ± 141 mg/dL. AKI was observed in 16 children (45.7%), predominantly mild forms (93.75% "risk"). AKI group presented lower levels of platelets (69,131 ± 40,247 vs. 138,678 ± 127,494/mm, P = 0.035) than non-AKI. No patient required dialysis and there was no death.
Conclusions:
HLH was not a rare complication of VL. Main symptoms were compatible with both VL and HLH. Main laboratory findings reflected HLH pathophysiology. Mild forms of AKI were a common complication of HLH. Despite the disease severity and complications, mortality was low.
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