Clinico-Hematological Findings of Acute Pediatric Visceral Leishmaniasis Referred to the Northeast of Iran during 2005-2015
-
Shaghik BARANI
,
Habibollah TURKI
,
Reza SHAFIEI
,
Fatemeh JAFARZADEH
,
Hoda HOSSEINZADEH MALEKI
,
Saber RAEGHI
Abstract
Background: To characterize the epidemiological, clinical, hematological and biochemical features of 33 cases hospitalized with pediatric visceral leishmaniasis (PVL) in North Khorasan Province of Iran from 2005 to 2015.
Methods: The serological, hematological and biochemical tests were employed in 33 children between 8 months to 6 yr with a final diagnosis of acute visceral leishmaniasis (VL). The diagnosis of VL was established by microscopic demonstration of Leishmania spp. amastigotes inactive bone marrow aspiration (BMA).
Results: The most common presenting features were anemia (82.5%), fever (75%), and hepatosplenomegaly (45.4%). Various hematological parameters showed that most patients were suffering from moderate to severe microcytic hypochromic anemia (78.8% had RBC count less than 4 million cells/ul, 67.7% Hb less than 8 fl). 66.7% of them were leukopenic (WBC: less than 5× 103 /μL) and 24.2% had decreased platelet counts. Pancytopenia was observed in 18.2% of cases. MCV, MCH, and MCHC levels were below the reference range in 88%, 90% and 85.1% of the patients respectively. Moreover, aspartate transaminase (AST) and alanine transaminase (ALT) levels were increased in 53.33% and 6.66% of the patients respectively. 92.9% of cases were C-reactive protein (CRP) positive. Bone marrow was found hyper-cellular in all of them, and myeloid to erythroid ratio (M/E) was more than 4 in 39.1% of cases. Plasma cells slightly were increased in 60% of patients and megakaryocytes were decreased in thrombocytopenic patients.
Conclusion: Bone marrow/splenic aspiration still remains the gold standard test despite its risk and pain for patients.
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20. Rahi AA, Ali MA, Keshavarz Valian H, et al. Seroepidemiological studies of visceral leishmaniasis in Iraq. Sch J App Med Sci, 2013;1(6):985-989.
21. Al-Hamash SM. Study of visceral leishmaniasis (kala-azar) in children of Iraq. Mustansiriya Med J. 2012;11:15-9.
22. Al-Orainey IO, Gasim IY, Singh LM, et al. Visceral leishmaniasis in Gizan, Saudi Arabia. Ann Saudi med. 1994;14(5):396-8.
23. Chappuis F, Sundar S, Hailu A, et al. Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol. 2007;5(11):873-82.
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25. Rodrigues V, Cordeiro-da-Silva A, Laforge M, et al. Regulation of immunity during visceral Leishmania infection. Parasit Vectors. 2016;9(1):118.
26. Abdossamadi Z, Seyed N, Zahedifard F, et al. Human Neutrophil Peptide 1 as immunotherapeutic agent against Leishmania infected BALB/c mice. PLoS Negl Trop Dis. 2017;11(12): e0006123.
27. Srivastava P, Dayama A, Mehrotra S, et al. Diagnosis of visceral leishmaniasis.Trans R Soc Trop Med Hyg. 2011;105(1):1-6.
28. Chulay JD, Bryceson AD. Quantitation of amastigotes of Leishmania donovani in smears of splenic aspirates from patients with visceral leishmaniasis.Am J Trop Med Hyg. 1983;32(3):475-9.
29. Neki N, Singh J. Hematological changes in Visceral Leishmaniasis. Int J Curr Res Med Sci. 2017;3(6):36-40.
30. Rai ME, Muhammad Z, Sarwar J, et al. Haematological findings in relation to clinical findings of visceral Leishmaniasis in Hazara Division. J Ayub Med Coll Abbottabad. 2008;20(3):40-3.
31. Mirahmadi H, Rezaee N, Mehravaran A, et al. Detection of species and molecular typing of Leishmania in suspected patients by targeting cytochrome b gene in Zahedan, southeast of Iran. Vet World. 2018; 11(5):700-705.
32. Marwaha N, Sarode R, Gupta R, et al. Clinico-hematological characteristics in patients with kala azar. A study from north-west India. Trop Geogr Med. 1991;43(4):357-62.
33. Novotná M, Havlíček J, Smith AP,et al. Toxoplasma and reaction time: role of toxoplasmosis in the origin, preservation and geographical distribution of Rh blood group polymorphism. Parasitology. 2008;135(11):1253-61.
34. Flegr J, Novotná M, Lindová J, et al. Neurophysiological effect of the Rh factor. Protective role of the RhD molecule against Toxoplasma-induced impairment of reaction times in women. Neuro Endocrinol Lett. 2008;29(4):475-81.
35. Flegr J, Klose J, Novotná M, et al. Increased incidence of traffic accidents in Toxoplasma-infected military drivers and protective effect RhD molecule revealed by a large-scale prospective cohort study. BMC Iinfect Dis. 2009;9(1):72.
2. Shafiei R, Namdar Ahmadabad H, Nezafat Firizi M, et al. Cytokine profile and nitric oxide levels in macrophages exposed to Leishmania infantum FML. Exp Parasitol. 2019;203:1-7
3. Badirzadeh A, Heidari-Kharaji M, Fallah-Omrani V, et al. Antileishmanial activity of Urtica dioica extract against zoonotic cutaneous leishmaniasis. PLoS Negl Trop Dis. 2020; 14(1): e0007843.
4. Hashemi SA, Badirzadeh A, Sabzevari S,et al. First case report of atypical disseminated cutaneous leishmaniasis in an opium abuser in Iran.Rev Inst Med Trop Sao Paulo. 2018;60: e5.
5. Arzamani K. Visceral leishmaniasis in North Khorasan Province, north east of Iran. Int J Infect Dis. 2012;16:e340-e1.
6. Badirzadeh A, Mohebali M, Sabzevari S,et al. Case report: First coinfection report of mixed Leishmania infantum/Leishmania major and human immunodeficiency virus–acquired immune deficiency syndrome: report of a case of disseminated cutaneous leishmaniasis in Iran. Am J Trop Med Hyg. 2018;98(1): 122-5.
7. Mirahmadi H, Mansouri Nia M, Ebrahimzadeh A, et al. Genotyping determination of Acanthamoeba strains: an original study and a systematic review in Iran. J Water Health. 2019;17:717-727.
8. Shafiei R, Ghatee MA, Jafarzadeh F, et al. Geno-typing and phylogenetic analysis of unusually locat-ed hydatid cysts isolated from humans in north-east Iran. J Helminthol.2019;94:e64.
9. Sarkari B, Parhoode M, Khabisi SA, et al. Genetic diversity of Fasciola spp. isolates from northern part of Iran: comparison with southwestern isolates. J Parasit Dis.2017;41:768-772.
10. Sarkari B, Lari M, Shafiei R, et al. A comparative seroprevalence study of toxocariasis in hypereosin-ophilic and apparently healthy individuals. Arch Pe-diatr Infect Dis. 2015;3:e17911.
11. Badirzadeh A, Mohebali M, Asadgol Z, et al. The burden of leishmaniasis in Iran, acquired from the global burden of disease during 1990–2010. Asian Pacific J Trop Dis. 2017;7(9):513-518.
12. Edrissian Gh H, Nadim A, Alborzi AV, et al. Vis-ceral leishmaniasis: the Iranian experiences. Arch Iranian Med. 1998;1:22-6.
13. Sharifi I, Aflatoonian MR, Parizi MHD,et al. Visceral Leishmaniasis in Southeastern Iran: A Narrative Review. Iran J Parasitol. 2017;12(1):1-11.
14. Mohebali M, Arzamani K, Zarei Z, et al. Canine visceral leishmaniasis in Wild Canines (Fox, Jackal, and Wolf) in Northeastern Iran using parasitological, serological, and molecular methods. J Arthropod Borne Dis. 2016;10(4):538-545.
15. Varma N, Naseem S. Hematologic Changes in Visceral Leishmaniasis/Kala Azar. Indian J Hematol Blood Transfus. 2010;26(3):78-82.
16. Karimi A, Alborzi A, Amanati A. Visceral Leishmaniasis: An Update and Literature Review. Arch Pediatr Infect Dis. 2016;4(3):e31612
17. Sampaio MJ, Cavalcanti NV, Alves JG, et al. Risk factors for death in children with visceral leishmaniasis. PLoS Negl Trop Dis. 2010;4(11):e877.
18. Sarkari B, Rezaei Z, Mohebali M. Immunodiagnosis of Visceral Leishmaniasis: Current Status and Challenges: A Review Article. Iran J Parasitol. 2018;13(3):331-341.
19. Mohebali M. Visceral leishmaniasis in Iran: review of the epidemiological and clinical features. Iran J Parasitol. 2013;8(3):348-58.
20. Rahi AA, Ali MA, Keshavarz Valian H, et al. Seroepidemiological studies of visceral leishmaniasis in Iraq. Sch J App Med Sci, 2013;1(6):985-989.
21. Al-Hamash SM. Study of visceral leishmaniasis (kala-azar) in children of Iraq. Mustansiriya Med J. 2012;11:15-9.
22. Al-Orainey IO, Gasim IY, Singh LM, et al. Visceral leishmaniasis in Gizan, Saudi Arabia. Ann Saudi med. 1994;14(5):396-8.
23. Chappuis F, Sundar S, Hailu A, et al. Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol. 2007;5(11):873-82.
24. Sarkari B, Naraki T, Ghatee MA, et al. Visceral Leishmaniasis in Southwestern Iran: A Retrospective Clinico-Hematological Analysis of 380 Consecutive Hospitalized Cases (1999-2014). PloS One. 2016;11(3):e0150406.
25. Rodrigues V, Cordeiro-da-Silva A, Laforge M, et al. Regulation of immunity during visceral Leishmania infection. Parasit Vectors. 2016;9(1):118.
26. Abdossamadi Z, Seyed N, Zahedifard F, et al. Human Neutrophil Peptide 1 as immunotherapeutic agent against Leishmania infected BALB/c mice. PLoS Negl Trop Dis. 2017;11(12): e0006123.
27. Srivastava P, Dayama A, Mehrotra S, et al. Diagnosis of visceral leishmaniasis.Trans R Soc Trop Med Hyg. 2011;105(1):1-6.
28. Chulay JD, Bryceson AD. Quantitation of amastigotes of Leishmania donovani in smears of splenic aspirates from patients with visceral leishmaniasis.Am J Trop Med Hyg. 1983;32(3):475-9.
29. Neki N, Singh J. Hematological changes in Visceral Leishmaniasis. Int J Curr Res Med Sci. 2017;3(6):36-40.
30. Rai ME, Muhammad Z, Sarwar J, et al. Haematological findings in relation to clinical findings of visceral Leishmaniasis in Hazara Division. J Ayub Med Coll Abbottabad. 2008;20(3):40-3.
31. Mirahmadi H, Rezaee N, Mehravaran A, et al. Detection of species and molecular typing of Leishmania in suspected patients by targeting cytochrome b gene in Zahedan, southeast of Iran. Vet World. 2018; 11(5):700-705.
32. Marwaha N, Sarode R, Gupta R, et al. Clinico-hematological characteristics in patients with kala azar. A study from north-west India. Trop Geogr Med. 1991;43(4):357-62.
33. Novotná M, Havlíček J, Smith AP,et al. Toxoplasma and reaction time: role of toxoplasmosis in the origin, preservation and geographical distribution of Rh blood group polymorphism. Parasitology. 2008;135(11):1253-61.
34. Flegr J, Novotná M, Lindová J, et al. Neurophysiological effect of the Rh factor. Protective role of the RhD molecule against Toxoplasma-induced impairment of reaction times in women. Neuro Endocrinol Lett. 2008;29(4):475-81.
35. Flegr J, Klose J, Novotná M, et al. Increased incidence of traffic accidents in Toxoplasma-infected military drivers and protective effect RhD molecule revealed by a large-scale prospective cohort study. BMC Iinfect Dis. 2009;9(1):72.
| Files | ||
| Issue | Vol 15 No 2 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijpa.v15i2.3303 | |
| Keywords | ||
| Visceral leishmaniasis Leishmania infantum Bone marrow examina-tion Hematological features | ||
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How to Cite
1.
BARANI S, TURKI H, SHAFIEI R, JAFARZADEH F, HOSSEINZADEH MALEKI H, RAEGHI S. Clinico-Hematological Findings of Acute Pediatric Visceral Leishmaniasis Referred to the Northeast of Iran during 2005-2015. Iran J Parasitol. 2020;15(2):214-222.
