2024/12/31 by Hamouda, S., Belhadj I ., Boussetta, A. +4
#Child #Infant Visceral Leishmaniasis #Leishmaniose viscérale infantile #Macrophage activation syndrome #Myelogram #enfant #myélogramme #syndrome d’activation macrophagique
paper · doi:10.71566/pist-rmp-194913
"Introduction: The incidence of infantile visceral leishmaniasis (IVL) tends to increase particularly in young children. The aim of our study was to analyze the means used for the diagnosis of the disease and its complications. Matériel et méthodes : Our study was retrospective including patients with IVL diagnosed between 2004 and 2015. For each patient, clinical data at diagnosis and during follow-up were analyzed from medical re- cords as well as the results of the investigations undertaken. Results : A total of 28 patients aged 16 months on average were examened. The clinical triad associating fe- ver, pallor, and splenomegaly was present in 27 cases. Hepatomegaly was found in 22 patients. The blood count showed pancytopenia (n = 16) or bicytopenia (n = 12). Autoimmune hemolytic anemia was present in 4 cases. All patients had at least one myelogram. It revealed the bodies of Leishmania in 27 cases and was inconclusive in one patient. In the latter, the diagnosis was made through positive PCR. A posi- tive leishmaniasis serology and a positive ""Western blot"" technique guided the second interpretation of the myelogram in 5 and 2 cases respectively. The mean time for diagnosis was 6 days. IVL was com- plicated by macrophage activation syndrome (MAS) in 4 cases. Its diagnosis was primarily biological (n = 3). One patient presented IVL relapse after 5 months, diagnosed by PCR, and another patient with MAS died due to severe sepsis. Conclusion : In most of the cases, the diagno- sis of IVL is based on myelogram, an invasive tool with difficulty in its analysis. MAS is a common and serious complication of IVL. Its diagnosis is mostly clinical and biological. "