[Urban outbreak of visceral leishmaniasis in Neiva (Colombia)]

Objective Characterize the foci of visceral leishmaniasis infection in Neiva with a clinical and epidemiological approach. Materials and Methods Six children consulted medical services with hepatosplenomegaly. They were found to have anemia and leukopenia. The diagnosis was performed by bone marrow (five patients) and spleen (1 patient) aspiration. An active search for cases was carried out in the community. Anti-Leishmania infantum antibodies were also sought out using indirect immunofluorescence (IIF) in symptomatic patients and in dogs (IFI, rK39). House calls were made in order to carry out educational activities and to collect disease vectors. Patients received miltefosine, amphotericin B or Glucantime®. Results LV was confirmed in seven children. In six of them, the bone marrow or spleen aspirate contained amastigotes. The IIF was positive in 4 patients and negative in 3. One child was detected throught the active community search, confirmed by the clinic with IIF (1:32). Six patients were cured with liposomal amphotericin B (o deoxycholate) and one patient was cured with Glucantime®. The canine seroprevalence in 1182 dogs was 6.1% (IFI and rK39); the positive animals were destroyed. L. longipalpis was found in the houses. This is the principal vector of LV in Colombia. Conclusions The study showed that two zones of Neiva have children infected with LV. Diagnostic confirmation must include aspiration of bone marrow and IIFs. Treatment with miltefosine was not helpful, but liposomal amphotericin B is an ideal therapy. To control LV, active case searching, community education and vector and reservoir control is necessary.