Visceral leishmaniasis: a common cause of post-infectious febrile pancytopenia in children in an endemic area: experience of a children's tertiary hospital.
BACKGROUND
Visceral leishmaniasis (VL, kala-azar) is caused by Leishmania spp, a parasite that is commonly encountered in Mediterranean countries. Leishmaniasis usually presents with fever, hepatosplenomegaly, lymphadenopathy, and pancytopenia.


OBJECTIVE
The aim of the study was to prospectively examine the characteristics of cytopenia associated with VL and compare it with other post-infectious cytopenias observed in children with febrile illnesses.


METHODS
We studied 112 children, aged (mean) 4.0 (SD, 3.8) years (range, 0-14 years), who were admitted to the pediatric ward because of febrile cytopenia associated with infections, during a 2-year period (March 2005 to June 2007). Study participants were investigated with measurement of acute-phase reactants, bacterial cultures, and serologic tests.


RESULTS
Pancytopenia was detected in 9 (8%) of 112 patients (5 boys), with a mean age of 4.5 (SD, 3.0) years.The mean value of white blood cell was 3827 (SD, 1455)/mL; absolute neutrophil count, 1229 (SD, 655)/mL; hemoglobin, 8.3 (SD, 1.1) g/dL; and platelet count, 88,200 (SD, 20,186)/mL. All patients with pancytopenia had fever (mean duration, 8.9 [SD, 8.7] days) (maximum temperature, 39.5°C [SD, 0.6°C]) and hepatosplenomegaly (9/9), whereas 2 of 9 had lymphadenopathy. In these patients, a bone marrow aspiration was performed, and VL was detected in all 9 samples. They were treated with liposomal amphotericin B and had an excellent response rate. Pancytopenia resolved within a mean period of 17.6 (SD, 17.3) days (range, 8-60 days), and there was no relapse during a 2 years' follow-up.


CONCLUSIONS
In endemic countries, leishmaniasis is the main cause of febrile pancytopenia among children in whom hematologic malignancy has been ruled out.
2nd Department of Pediatrics, University of Athens, Greece. ragean@yahoo.gr
Ourania
O
Alexandropoulou
Maria
M
Tsolia
Lydia
L
Kossiva
Maria
M
Giannaki
Kyriaki
K
Karavanaki
D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000150:complications / Q000453:epidemiology; D019353:Endemic Diseases; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D010198:Pancytopenia / Q000453:epidemiology* / Q000469:parasitology*; D011446:Prospective Studies
D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B