ArticleOpen forum infectious diseases2025
Diagnosis and Management of Visceral Leishmaniasis in Children: A French Retrospective Study.
Article in Open forum infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Few studies have investigated the diagnosis and management of pediatric visceral leishmaniasis (VL) in high-income countries. Methods: All children hospitalized for VL in university hospitals across mainland France between January 2012 and August 2022 were included in this retrospective study. Results: Sixty-three patients were included with an M/F sex ratio of 1.25 and a median age of 2 years (IQR: 1; 5.4). At least 36 patients had autochthonous VL. The median delay between symptom onset and diagnosis was 20 days (IQR: 11.7; 35.2) [1-193]. The most common symptoms were fever (92%) and splenomegaly (78%). Biological findings included inflammatory syndrome (90%), pancytopenia (79%), and hepatic cytolysis (52%). Twenty-four children (44%) presented hemophagocytic lymphohistiocytosis (HLH). Bone marrow smears, bone marrow real-time PCR (qPCR), and blood qPCR were positive for VL in 64%, 90%, and 96% of the tested patients, respectively. Positivity reached 100% in patients who underwent combined blood and bone marrow PCR. All the patients were treated with liposomal amphotericin B (chemical name, (1R,3S,5R,6R,9R,11R,15S,16R,17R,18S,19E,21E,23E,25E,27E,29E,31E,33R,35S,36R,37S)-33-[(2R,3S,4S,5S,6R)-4-amino-3,5-dihydroxy-6-methyloxan-2-yl]oxy-1,3,5,6,9,11,17,37-octahydroxy-15,16,18-trimethyl-13-oxo-14,39-dioxabicyclo[33.3.1]nonatriaconta-19,21,23,25,27,29,31-heptaene-36-carboxylic acid;2-aminoguanidine). Ten different regimens were used, ranging from 18 to 30 mg/kg cumulative doses given from 2 to 8 days. The median follow-up duration was 2.8 months. Four patients (6.3%) relapsed, one of whom was not retreated. All the children recovered. Conclusions: Pediatric VL remains rare in France, with long diagnostic delays and a high frequency of HLH. The combination of blood and bone marrow PCR optimizes the diagnosis. Standardization of therapeutic regimens and follow-up is necessary.
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