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Published on: April 4, 2025
Pediatric visceral leishmaniasis in northwest of Iran
Babak Abdinia1, Mohammad Oliaei-Motlagh, Amir Teimouri-Dereshki
1Department of Pediatrics, Faculty of Medicine Faculty of Medicine Medical Education Research Center, Tabriz University of Medical Sciences,Tabriz, Iran.
Insights
Visceral leishmaniasis (VL) is a significant health issue in northwestern Iran, particularly affecting children. Most pediatric cases responded well to glucantime treatment, with early diagnosis crucial for improving outcomes and reducing mortality.
Area of Science:
- Medical Science
- Infectious Diseases
- Pediatrics
Background:
- Leishmaniasis poses a major health challenge in Iran, with northwestern regions being highly endemic for visceral leishmaniasis (VL).
- Understanding the clinical and laboratory characteristics of pediatric VL is crucial for effective management in endemic areas.
Purpose of the Study:
- To investigate the clinical, laboratory, and disease characteristics of children diagnosed with visceral leishmaniasis in northwestern Iran.
- To evaluate treatment responses and mortality rates in pediatric VL cases.
Main Methods:
- Retrospective analysis of 156 children hospitalized for VL between 2000 and 2015 at a reference hospital in Tabriz, Iran.
- Data collected included demographic information, clinical manifestations (fever, splenomegaly, hepatomegaly), laboratory findings (anemia, thrombocytopenia, ESR, liver enzymes), treatment type, and outcomes.
Main Results:
- Fever and splenomegaly were the most prevalent symptoms (94.24% and 86.53%, respectively).
- Common laboratory findings included leukopenia (31.41%), anemia (41.02%), and elevated ESR (21.15% > 60).
- A high treatment success rate (96.2%) was observed with glucantime, and the overall mortality rate was 3.2%, with hepatic involvement noted in fatal cases.
Conclusions:
- Pediatric visceral leishmaniasis in northwestern Iran presents with characteristic clinical and laboratory findings, predominantly fever and splenomegaly.
- Glucantime is an effective primary treatment, with amphotericin B as a viable alternative for resistant cases.
- Early diagnosis and prompt treatment are vital for reducing morbidity and mortality associated with pediatric VL.
Abstract:
Leishmaniasis is one of the major health problems in Iran. Although the incidence of visceral leishmaniasis (VL) is reported almost everywhere, the northwestern Iran is one of the major endemic regions.To do this study, clinical, laboratory as well as disease characteristics of children admitted to Children Cure and Health Hospital, Tabriz University of Medical Sciences, were examined as the reference hospital for the treatment of VL in northwestern Iran.In this study, 156 children hospitalized in a pediatric hospital from 2000 to 2015 for VL were included. Gender, age, anemia, thrombocytopenia, increase in the erythrocyte sedimentation rate (ESR), alanine transaminase (SGPT), and aspartate transaminase (SGOT), major clinical manifestations such as fever, splenomegaly, hepatomegaly, treatment type, and the disease were studied.Among 156 patients examined in this study, 88 (56.41%) and 68 (43.59%) participants were male and female, respectively. The minimum and maximum ages of the infection were 4.5 months and 6 years, respectively. The mean age of the infected children was 17.94 months. Fever (94.24%) and splenomegaly (86.53%) were the most common symptoms of this disease among children. In addition, 49 (31.41%), 64 (41.02%), 18 (11.53%), 33 (21.15%), and 40 (25.64%) participants had leukopenia, hemoglobin count below 8, ESR above 100, ESR above 60, and platelets below 100,000, respectively. Moreover, 39 (25%) and 17 (10.89%) patients had high aspartate transaminase (AST) and alanine transaminase (ALT). Also, 96.2% of the participants responded to the treatment with glucantime. The rate of mortality in this study was 3.2%.Clinically, almost all children had fever and splenomegaly at the onset of the disease. In addition, hepatic involvement was observed in all cases of mortality, cases with a lack of initial response, and those in need of auxiliary medication. Hepatic involvement appears to be related to the prognosis of the disease. In our study, bone marrow aspiration (BMA) and positive direct antiglobulin test (DAT) were observed in 66.67% and more than 90% of the patients, respectively.Children with VL in northwestern Iran responded well to glucantime. In case of resistance, amphotericin B was a good alternative. Early diagnosis is essential in reducing mortality rate.
