title: Clinical characteristics and spatial distribution of Visceral leishmaniasis in children in São Paulo state: an emerging focus of Visceral leishmaniasis in Brazil.
abstract: BACKGROUND
  Visceral leishmaniasis (VL) is an emerging zoonosis, and Brazil harbors about 90% of those infected in Latin America. Since 1998, the disease has been spreading quickly in São Paulo state, and the western region is considered an emerging focus of VL in Brazil. Our aim was to evaluate the clinical characteristics and spatial distribution of VL in children referred to a public tertiary hospital located in the western region of São Paulo state, Brazil.
  
  
  METHODS
  Medical records of children up to 18 years of age who were diagnosed with VL between January 2006 and December 2010 were reviewed. Geospatial analysis was performed using the ArcGIS 10.2 platform.
  
  
  RESULTS
  Sixty-three patients were enrolled in the study; the median age was 3.3 ± 3.3 years. The median time interval between the onset of clinical symptoms and diagnosis was 16.1 ± 11.1 days, and the median time in the pediatric ward was 18.0 ± 9.4 days. Liposomal amphotericin B was the first-line treatment in 90.5% of the patients and 9.6% relapsed. One patient died (1.6%), and 19% were submitted to the pediatric intensive care unit.
  
  
  CONCLUSIONS
  The short interval between the onset of symptoms, diagnosis, and treatment and the reduced number of days of hospitalization certainly influenced the small number of deaths, relapses, and severity among the children infected with VL. However, the disease is spreading fast in the western region of São Paulo state. Thus, integrated actions and effective monitoring of the disease are needed to complement curative practices.
authors.affiliation: a Department of Pediatrics , Regional Hospital , Presidente Prudente , Brazil.
authors.forename: Patricia Rodrigues
authors.initials: PR
authors.lastname: Naufal Spir
authors.affiliation: b Department of Immunology and Infectious Diseases , University of Oeste Paulista , Presidente Prudente , Brazil.
authors.forename: Luiz Euribel
authors.initials: LE
authors.lastname: Prestes-Carneiro
authors.affiliation: c Department of Geography , São Paulo State University , Presidente Prudente , Brazil.
authors.forename: Elivelton Silva
authors.initials: ES
authors.lastname: Fonseca
authors.affiliation: a Department of Pediatrics , Regional Hospital , Presidente Prudente , Brazil.
authors.forename: Aline
authors.initials: A
authors.lastname: Dayse
authors.affiliation: b Department of Immunology and Infectious Diseases , University of Oeste Paulista , Presidente Prudente , Brazil.
authors.forename: Rogério
authors.initials: R
authors.lastname: Giuffrida
authors.affiliation: c Department of Geography , São Paulo State University , Presidente Prudente , Brazil.|d Center of Regional Laboratory V , Adolfo Lutz Institute , Presidente Prudente , Brazil.
authors.forename: Lourdes Aparecida Zampieri
authors.initials: LA
authors.lastname: D'Andrea
mesh_terms: D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D004283:Dog Diseases / Q000453:epidemiology; D004285:Dogs; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000662:veterinary; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D062206:Spatial Analysis
chemical_list: D000981:Antiprotozoal Agents; D000666:Amphotericin B
keywords: Visceral leishmaniasis; clinical symptoms; diagnosis; treatment