Clinico-Hematological Findings of Acute Pediatric Visceral Leishmaniasis Referred to the Northeast of Iran during 2005-2015

  • Shaghik BARANI Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
  • Habibollah TURKI Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
  • Reza SHAFIEI Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
  • Fatemeh JAFARZADEH Department of Parasitology, Shahid Beheshti Universtiy of Medical Sciences, Tehran, Iran
  • Hoda HOSSEINZADEH MALEKI Mashhad University of Medical Sciences, Mashhad, Iran
  • Saber RAEGHI Department of Laboratory Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
Keywords:
Visceral leishmaniasis, Leishmania infantum, Bone marrow examina-tion, Hematological features

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.

References

1. Gramiccia M, Gradoni L. The current status of zoonotic leishmaniases and approaches to disease control. Int J Parasitol. 2005;35(11-12):1169-80.
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.
Published
2020-06-07
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. 15(2):214-222.
Section
Original Article(s)