Visceral Leishmaniasis (VL) Clinical Presentation, Laboratory Findings, Treatment Options and Outcome
Abstract
Background: Black disease, also known as visceral leishmaniasis (VL), is a parasitic illness caused by various Leishmania species. The risk of morbidity and mortality increases with delayed diagnosis and treatment. Early VL diagnosis and fast appropriate treatment are critical issues in endemic areas.
Methods: This study was a retrospective cross-sectional study to investigate the diagnostic and therapeutic course of patients admitted with the diagnosis of VL in the Children's Medical Center (CMC) Hospital, Tehran, Iran. All cases of VL in patients under the age of 18 hospitalized between the years 2012 to 2022 were enrolled.
Results: Twenty-seven patients were enrolled with an average age of 28.13 months with the majority of females (51.8%). Common clinical signs were fever (96.2%) and splenomegaly (92.59%). However, lymphadenopathy was rare. The largest number of patients was from Tehran Province, followed by Ardabil, Khuzestan, Gilan, and Alborz provinces. The most common hematological abnormalities were anemia (85.1%) and thrombocytopenia (44.4%). In accordance with the treatment strategy, liposomal amphotericin B and amphotericin B deoxycholate were given to 11 and 5 patients, respectively. Eleven of them received glucantime. The average length of hospitalization for liposomal amphotericin B was 15.36 ± 12.49 days. In comparison with glucantime (18.38 ±10.26 days) and amphotericin B deoxycholate (20.20± 6.18 days), liposomal amphotericin B group hospitalization was shorter than others were.
Conclusion: VL should be included in the differential diagnosis of any child who presents with fever, splenomegaly, and anemia. Concerning the treatment strategy in this study, liposomal amphotericin B had more efficiency and shorter hospitalization duration.
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2. Georgiadou SP, Makaritsis KP, Dalekos GN. Leishmaniasis revisited: Current aspects on epidemiology, diagnosis and treatment. J Transl Int Med. 2015;3(2):43-50.
3. Najafi L, Omidian M, Rezaei Z, et al. Molecular and serological evaluation of zoonotic visceral leishmaniasis in dogs in a rural area of Fars province, southern iran, as a source of Leishmania Infantum infection. Vet Med Sci. 2021;7:1082-1089.
4. van Griensven J, Diro E. Visceral leishmaniasis. Infect Dis Clin North Am. 2012;26:309-322.
5. Burza S, Croft SL, Boelaert M. Leishmaniasis. Lancet. 2018;392:951-970.
6. Nuwayri-Salti N, Knio K, Jammoul A, Fakhoury R, Sarhane KA, Nakkash-Chmaisse H. Atypical systemic leishmaniasis to be considered in the differential of patients presenting with depressed immunity. PLoS Negl Trop Dis. 2012;6:e1782.
7. Kumar PV, Omrani GH, Saberfirouzi M, Arshadi C, Arjmand F, Parhizgar A. Kala-azar: Liver fine needle aspiration findings in 23 cases presenting with a fever of unknown origin. Acta Cytol. 1996;40:263-268.
8. Mohebali M. Visceral leishmaniasis in iran: Review of the epidemiological and clinical features. Iran J Parasitol. 2013;8:348-358.
9. Gama MEA, Costa JML, Gomes CMC, Corbett CEP. Subclinical form of the american visceral leishmaniasis. Mem Inst Oswaldo Cruz. 2004;99:889-893.
10. Abuzaid AA, Aldahan MA, Helal MAA, Assiri AM, Alzahrani MH. Visceral leishmaniasis in saudi arabia: From hundreds of cases to zero. Acta Trop. 2020;212:105707.
11. Aleixo J, Nascimento E, Monteiro G, et al. american visceral leishmaniasis caused by disseminated Leishmania amazonensis infection presenting with hepatitis and adenopathy. Trans R Soc Trop Med Hyg. 2006;100:79-82.
12. Afshoon M, Abdolsalehi M, Alinia G, Borhani K, Yaghmaie B, Khodabandeh M. Disseminated leishmaniasis due to using immunosuppression drugs: A case report. Iran J Parasitol. 2020;15:278-281.
13. Chappuis F, Sundar S, Hailu A, et al. Visceral leishmaniasis: What are the needs for diagnosis, treatment and control? Nat Rev Microbiol. 2007;5:873-882.
14. De Ruiter C, Van Der Veer C, Leeflang M, Deborggraeve S, Lucas C, Adams E. Molecular tools for diagnosis of visceral leishmaniasis: Systematic review and meta-analysis of diagnostic test accuracy. J Clin Microbiol. 2014;52:3147-3155.
15. Sundar S, Chakravarty J. An update on pharmacotherapy for leishmaniasis. Expert Opin Pharmacother. 2015;16:237-252.
16. Mcgwire BS, Satoskar A. Leishmaniasis: Clinical syndromes and treatment. QJM. 2014;107:7-14.
17. Gradoni L, López-Vélez R, Mokni M. Manual on case management and surveillance of the leishmaniases in the WHO European region. 2017
18. Mazire P, Agarwal V, Roy A. Road‐map of pre‐clinical treatment for visceral leishmaniasis. Drug Dev Res. 2022;83:317-327.
19. Gradoni L, Bryceson A, Desjeux P. Treatment of mediterranean visceral leishmaniasis. Bull World Health Organ. 1995;73:191-197.
20. Sasidharan S, Saudagar P. Leishmaniasis: Where are we and where are we heading? Parasitol Res. 2021;120:1541-1554.
21. Moore EM, Lockwood DN. Treatment of visceral leishmaniasis. J Glob Infect Dis. 2010;2:151-158.
22. Catania S, Aiassa C, Tzahtzoglou S, et al. Visceral leishmaniasis treated with liposomal amphotericin b. Pediatr Infect Dis J. 1999;18:73-74.
23. Scarpini S, Dondi A, Totaro C, et al. Visceral leishmaniasis: Epidemiology, diagnosis, and treatment regimens in different geographical areas with a focus on pediatrics. Microorganisms. 2022; 10:1887.
24. Barani S, Turki H, Shafiei R, et al Clinico-hematological findings of acute pediatric visceral leishmaniasis referred to the northeast of Iran during 2005-2015. Iran J Parasitol. 2020;15:214-222.
25. Sarkari B, Naraki T, Ghatee MA, Abdolahi Khabisi S, Davami MH. Visceral leishmaniasis in southwestern Iran: A retrospective clinico-hematological analysis of 380 consecutive hospitalized cases (1999–2014). PLoS One. 2016;11:e0150406.
26. Sarkari B, Hatam G, Ghatee M. Epidemiological features of visceral leishmaniasis in Fars province, southern iran. Iran J Public Health. 2012;41:94-99.
27. Sarkari B, Pedram N, Mohebali M, et al. Seroepidemiological study of visceral leishmaniasis in Booyerahmad district, south-west Islamic Republic of Iran. East Mediterr Health J. 2010; 16 (11):1133-1136.
28. Rostamian M, Bashiri H, Yousefinejad V, et al. Prevalence of human visceral leishmaniasis in Iran: A systematic review and meta-analysis. Comp Immunol Microbiol Infect Dis. 2021;75:101604.
29. Soleimanzadeh G, Edrissian GH, Movahhed-Danesh A, Nadim A. Epidemiological aspects of kala-azar in Meshkin-Shahr, Iran: Human infection. Bull World Health Organ. 1993;71:759-62.
30. Sharifi I, Aflatoonian MR, Daei Parizi MH, et al. Visceral leishmaniasis in southeastern iran: A narrative review. Iran J Parasitol. 2017;12:1-11.
31. Abdinia B, Oliaei-Motlagh M, Teimouri-Dereshki A. Pediatric visceral leishmaniasis in northwest of iran. Medicine (Baltimore). 2016;95:e5261.
32. Heidari A, Mohebali M, Kabir K, et al. Visceral leishmaniasis in rural areas of Alborz province of iran and implication to health policy. Korean J Parasitol. 2015;53:379-383.
33. Nouri L, Al-Jeboori T. Kala-azar in Iraq. An epidemiological and cmnical study. J Fac Med Baghdad. 1973;15:72-85.
34. Tarekegn B, Tamene A. Clinical and laboratory profiles of visceral leishmaniasis among adult patients admitted to Felege Hiwot Hospital, Bahir Dar, Ethiopia. SAGE Open Med. 2021;9:20503121211036787.
35. Nourian M, Heidari A, Tajali S, Ghasemi E, Mohebali M, Heidari A. Paediatric visceral leishmaniasis: A retrospective study on clinical manifestations, demographic features and laboratory findings of hospitalised cases in Iran between 2006 and 2016. Trop Doct. 2019;49:59-61.
36. Tofighi Naeem A, Mahmoudi S, Saboui F, et al. Clinical features and laboratory findings of visceral leishmaniasis in children referred to Children Medical Center Hospital, Tehran, Iran during 2004-2011. Iran J Parasitol. 2014;9:1-5.
37. Rahim KM, Ashkan MM. Epidemiological, clinical and therapeutic features of pediatric kala-azar. Southeast Asian J Trop Med Public Health. 2007;38:626-630.
38. Barati M, Daie Parizi M, Sharifi I. Epidemiological and clinical aspects of kala-azar in hospitalized children of Kerman province, during 1991-2006. Journal of Kerman University of Medical Sciences. 2008;15:148-155.
39. Kafetzis D, Velissariou I, Stabouli S, Mavrikou M, Delis D, Liapi G. Treatment of paediatric visceral leishmaniasis: Amphotericin b or pentavalent antimony compounds? Int J Antimicrob Agents. 2005;25:26-30.
40. Apa H, Devrim İ, Bayram N, Deveci R, Demir-Özek G, Carti ÖU. Liposomal amphotericin b versus pentavalent antimony salts for visceral Leishmania in children. Turk J Pediatr. 2013;55:378-83.
41. Cascio A, di Martino L, Occorsio P, Giacchino R, Catania S, Gigliotti AR, Aiassa C, Iaria C, Giordano S, Colomba C. A 6 day course of liposomal amphotericin b in the treatment of infantile visceral leishmaniasis: The Italian experience. J Antimicrob Chemother. 2004;54:217-220.
2. Georgiadou SP, Makaritsis KP, Dalekos GN. Leishmaniasis revisited: Current aspects on epidemiology, diagnosis and treatment. J Transl Int Med. 2015;3(2):43-50.
3. Najafi L, Omidian M, Rezaei Z, et al. Molecular and serological evaluation of zoonotic visceral leishmaniasis in dogs in a rural area of Fars province, southern iran, as a source of Leishmania Infantum infection. Vet Med Sci. 2021;7:1082-1089.
4. van Griensven J, Diro E. Visceral leishmaniasis. Infect Dis Clin North Am. 2012;26:309-322.
5. Burza S, Croft SL, Boelaert M. Leishmaniasis. Lancet. 2018;392:951-970.
6. Nuwayri-Salti N, Knio K, Jammoul A, Fakhoury R, Sarhane KA, Nakkash-Chmaisse H. Atypical systemic leishmaniasis to be considered in the differential of patients presenting with depressed immunity. PLoS Negl Trop Dis. 2012;6:e1782.
7. Kumar PV, Omrani GH, Saberfirouzi M, Arshadi C, Arjmand F, Parhizgar A. Kala-azar: Liver fine needle aspiration findings in 23 cases presenting with a fever of unknown origin. Acta Cytol. 1996;40:263-268.
8. Mohebali M. Visceral leishmaniasis in iran: Review of the epidemiological and clinical features. Iran J Parasitol. 2013;8:348-358.
9. Gama MEA, Costa JML, Gomes CMC, Corbett CEP. Subclinical form of the american visceral leishmaniasis. Mem Inst Oswaldo Cruz. 2004;99:889-893.
10. Abuzaid AA, Aldahan MA, Helal MAA, Assiri AM, Alzahrani MH. Visceral leishmaniasis in saudi arabia: From hundreds of cases to zero. Acta Trop. 2020;212:105707.
11. Aleixo J, Nascimento E, Monteiro G, et al. american visceral leishmaniasis caused by disseminated Leishmania amazonensis infection presenting with hepatitis and adenopathy. Trans R Soc Trop Med Hyg. 2006;100:79-82.
12. Afshoon M, Abdolsalehi M, Alinia G, Borhani K, Yaghmaie B, Khodabandeh M. Disseminated leishmaniasis due to using immunosuppression drugs: A case report. Iran J Parasitol. 2020;15:278-281.
13. Chappuis F, Sundar S, Hailu A, et al. Visceral leishmaniasis: What are the needs for diagnosis, treatment and control? Nat Rev Microbiol. 2007;5:873-882.
14. De Ruiter C, Van Der Veer C, Leeflang M, Deborggraeve S, Lucas C, Adams E. Molecular tools for diagnosis of visceral leishmaniasis: Systematic review and meta-analysis of diagnostic test accuracy. J Clin Microbiol. 2014;52:3147-3155.
15. Sundar S, Chakravarty J. An update on pharmacotherapy for leishmaniasis. Expert Opin Pharmacother. 2015;16:237-252.
16. Mcgwire BS, Satoskar A. Leishmaniasis: Clinical syndromes and treatment. QJM. 2014;107:7-14.
17. Gradoni L, López-Vélez R, Mokni M. Manual on case management and surveillance of the leishmaniases in the WHO European region. 2017
18. Mazire P, Agarwal V, Roy A. Road‐map of pre‐clinical treatment for visceral leishmaniasis. Drug Dev Res. 2022;83:317-327.
19. Gradoni L, Bryceson A, Desjeux P. Treatment of mediterranean visceral leishmaniasis. Bull World Health Organ. 1995;73:191-197.
20. Sasidharan S, Saudagar P. Leishmaniasis: Where are we and where are we heading? Parasitol Res. 2021;120:1541-1554.
21. Moore EM, Lockwood DN. Treatment of visceral leishmaniasis. J Glob Infect Dis. 2010;2:151-158.
22. Catania S, Aiassa C, Tzahtzoglou S, et al. Visceral leishmaniasis treated with liposomal amphotericin b. Pediatr Infect Dis J. 1999;18:73-74.
23. Scarpini S, Dondi A, Totaro C, et al. Visceral leishmaniasis: Epidemiology, diagnosis, and treatment regimens in different geographical areas with a focus on pediatrics. Microorganisms. 2022; 10:1887.
24. Barani S, Turki H, Shafiei R, et al Clinico-hematological findings of acute pediatric visceral leishmaniasis referred to the northeast of Iran during 2005-2015. Iran J Parasitol. 2020;15:214-222.
25. Sarkari B, Naraki T, Ghatee MA, Abdolahi Khabisi S, Davami MH. Visceral leishmaniasis in southwestern Iran: A retrospective clinico-hematological analysis of 380 consecutive hospitalized cases (1999–2014). PLoS One. 2016;11:e0150406.
26. Sarkari B, Hatam G, Ghatee M. Epidemiological features of visceral leishmaniasis in Fars province, southern iran. Iran J Public Health. 2012;41:94-99.
27. Sarkari B, Pedram N, Mohebali M, et al. Seroepidemiological study of visceral leishmaniasis in Booyerahmad district, south-west Islamic Republic of Iran. East Mediterr Health J. 2010; 16 (11):1133-1136.
28. Rostamian M, Bashiri H, Yousefinejad V, et al. Prevalence of human visceral leishmaniasis in Iran: A systematic review and meta-analysis. Comp Immunol Microbiol Infect Dis. 2021;75:101604.
29. Soleimanzadeh G, Edrissian GH, Movahhed-Danesh A, Nadim A. Epidemiological aspects of kala-azar in Meshkin-Shahr, Iran: Human infection. Bull World Health Organ. 1993;71:759-62.
30. Sharifi I, Aflatoonian MR, Daei Parizi MH, et al. Visceral leishmaniasis in southeastern iran: A narrative review. Iran J Parasitol. 2017;12:1-11.
31. Abdinia B, Oliaei-Motlagh M, Teimouri-Dereshki A. Pediatric visceral leishmaniasis in northwest of iran. Medicine (Baltimore). 2016;95:e5261.
32. Heidari A, Mohebali M, Kabir K, et al. Visceral leishmaniasis in rural areas of Alborz province of iran and implication to health policy. Korean J Parasitol. 2015;53:379-383.
33. Nouri L, Al-Jeboori T. Kala-azar in Iraq. An epidemiological and cmnical study. J Fac Med Baghdad. 1973;15:72-85.
34. Tarekegn B, Tamene A. Clinical and laboratory profiles of visceral leishmaniasis among adult patients admitted to Felege Hiwot Hospital, Bahir Dar, Ethiopia. SAGE Open Med. 2021;9:20503121211036787.
35. Nourian M, Heidari A, Tajali S, Ghasemi E, Mohebali M, Heidari A. Paediatric visceral leishmaniasis: A retrospective study on clinical manifestations, demographic features and laboratory findings of hospitalised cases in Iran between 2006 and 2016. Trop Doct. 2019;49:59-61.
36. Tofighi Naeem A, Mahmoudi S, Saboui F, et al. Clinical features and laboratory findings of visceral leishmaniasis in children referred to Children Medical Center Hospital, Tehran, Iran during 2004-2011. Iran J Parasitol. 2014;9:1-5.
37. Rahim KM, Ashkan MM. Epidemiological, clinical and therapeutic features of pediatric kala-azar. Southeast Asian J Trop Med Public Health. 2007;38:626-630.
38. Barati M, Daie Parizi M, Sharifi I. Epidemiological and clinical aspects of kala-azar in hospitalized children of Kerman province, during 1991-2006. Journal of Kerman University of Medical Sciences. 2008;15:148-155.
39. Kafetzis D, Velissariou I, Stabouli S, Mavrikou M, Delis D, Liapi G. Treatment of paediatric visceral leishmaniasis: Amphotericin b or pentavalent antimony compounds? Int J Antimicrob Agents. 2005;25:26-30.
40. Apa H, Devrim İ, Bayram N, Deveci R, Demir-Özek G, Carti ÖU. Liposomal amphotericin b versus pentavalent antimony salts for visceral Leishmania in children. Turk J Pediatr. 2013;55:378-83.
41. Cascio A, di Martino L, Occorsio P, Giacchino R, Catania S, Gigliotti AR, Aiassa C, Iaria C, Giordano S, Colomba C. A 6 day course of liposomal amphotericin b in the treatment of infantile visceral leishmaniasis: The Italian experience. J Antimicrob Chemother. 2004;54:217-220.
| Files | ||
| Issue | Vol 19 No 1 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijpa.v19i1.15190 | |
| Keywords | ||
| Visceral leishmaniasis Epidemiology Diagnosis Treatment Children Iran | ||
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How to Cite
1.
Khodabandeh M, Moradian E, Sarvari M, Soti Khiabani M. Visceral Leishmaniasis (VL) Clinical Presentation, Laboratory Findings, Treatment Options and Outcome. Iran J Parasitol. 2024;19(1):28-37.
