title: Spleen nodules: a potential hallmark of Visceral Leishmaniasis in young children.
abstract: BACKGROUND
  Visceral leishmaniasis (VL) is a severe disease caused by Leishmania infantum in the Mediterranean basin, and is associated with considerable morbidity and mortality. Infantile VL may begin suddenly, with high fever and vomiting, or insidiously, with irregular daily fever, anorexia, and marked splenomegaly. Delays in diagnosis of VL are common, highlighting the need for increased awareness of clinicians for VL in endemic European countries.
  
  
  METHODS
  We report 4 cases of young children in northern Italy presenting with persistent fever of unknown origin and diagnosed with VL by serological and molecular methods. At the time of diagnosis, these patients showed an unusual echographic pattern characterized by multiple iso-hypoechoic nodules associated with splenomegaly.
  
  
  CONCLUSIONS
  We suggest that detection of spleen nodules represents a signature of VL in infants, thus helping to diagnose systemic Leishmania infantum infection in children.
authors.affiliation: Pediatric Hematology and Oncology Unit St. Orsola-Malpighi Hospital University of Bologna, Via Massarenti 11, Bldg 13, Bologna, 40138, Italy. fraia.melchionda@aosp.bo.it.
authors.forename: Fraia
authors.initials: F
authors.lastname: Melchionda
authors.affiliation: Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), St. Orsola-Malpighi University Hospital, Bologna, Italy. stefania.varani@unibo.it.|Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. stefania.varani@unibo.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: Varani
authors.affiliation: Pediatric Radiology Unit, St. Orsola-Malpighi Hospital University of Bologna, Bologna, Italy. filomena.carfagnini@aosp.bo.it.
authors.forename: Filomena
authors.initials: F
authors.lastname: Carfagnini
authors.affiliation: Pediatric Hematology and Oncology Unit St. Orsola-Malpighi Hospital University of Bologna, Via Massarenti 11, Bldg 13, Bologna, 40138, Italy. tamara.belotti2@unibo.it.
authors.forename: Tamara
authors.initials: T
authors.lastname: Belotti
authors.affiliation: Unit of Vector-Borne Diseases and International Health, MIPI Department, Istituto Superiore di Sanità, Rome, Italy. trentina.dimuccio@iss.it.
authors.forename: Trentina
authors.initials: T
authors.lastname: Di Muccio
authors.affiliation: Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), St. Orsola-Malpighi University Hospital, Bologna, Italy. roberto.tigani@hotmail.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Tigani
authors.affiliation: Pediatric Unit, St. Orsola-Malpighi Hospital University of Bologna, Bologna, Italy. rosalba.bergamaschi@unibo.it.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Bergamaschi
authors.affiliation: Pediatric Hematology and Oncology Unit St. Orsola-Malpighi Hospital University of Bologna, Via Massarenti 11, Bldg 13, Bologna, 40138, Italy. andrea.pession@unibo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pession
mesh_terms: D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology; D006801:Humans; D007223:Infant; D007558:Italy; D018314:Leishmania infantum; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000175:diagnosis*; D008297:Male; D010808:Physical Examination; D013154:Spleen / Q000473:pathology*