title: Visceral leishmaniasis in pregnancy: a case series and a systematic review of the literature.
abstract: OBJECTIVE
  Visceral leishmaniasis (VL) is endemic in tropical and sub-tropical areas. Only anecdotal cases of VL in pregnancy are reported in the literature, although the disease is life-threatening for both mothers and infants. Here we report a small series of pregnant women with VL observed in the Neapolitan area over a 7 year period and carry out a systematic review of the literature on this topic.
  
  
  METHODS
  Consecutive cases of VL in HIV-negative female patients between 1996 and 2002 were evaluated. Pregnant women who fulfilled criteria for VL diagnosis were included and diagnostic, clinical and therapeutic features were considered. The outcome for both the pregnant woman and the fetus was evaluated over a 24 month period of post-therapy follow-up. A systematic search of English language literature through the MEDLINE database and Cochrane Library with the search strings 'leishmaniasis AND pregnancy' and 'leishmaniasis AND visceral AND congenital' integrated with a manual search completed our study.
  
  
  RESULTS
  Five consecutive pregnant women were diagnosed as having VL. Fever and hepatosplenomegaly were the main presenting symptoms. All received liposomal amphotericin B without any toxicity to either the mothers or newborns. No treatment failure or congenital VL case was observed. The systemic review of the literature revealed 17 cases of VL during pregnancy. Untreated VL resulted in consequences on the fetus or congenital VL.
  
  
  CONCLUSIONS
  The efficacy and safety of amphotericin B formulations for mother and fetus are supported by the cumulative analysis of our data and literature data.
authors.affiliation: I Division of Infectious Diseases, D. Cotugno Hospital, Naples. ppagliano@libero.it
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pagliano
authors.forename: Novella
authors.initials: N
authors.lastname: Carannante
authors.forename: Marco
authors.initials: M
authors.lastname: Rossi
authors.forename: Marina
authors.initials: M
authors.lastname: Gramiccia
authors.forename: Luigi
authors.initials: L
authors.lastname: Gradoni
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Faella
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Gaeta
mesh_terms: D000328:Adult; D000818:Animals; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000097:blood / Q000188:drug therapy*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000097:blood / Q000188:drug therapy*