Mediterranean visceral leishmaniasis in immunocompetent children. Report of two cases relapsed after specific therapy

Abstract

Visceral leishmaniasis (VL) is endemic in areas bordering the Mediterranean Sea (Spain, Italy, France, Greece, Morocco, Tunisia) where it is caused by Leishmania infantum and is transmitted by the bite of a hematophagous sandfly belonging to Phlebotomus spp.; the dog constitutes the main reservoir of infection. Two cases of VL in immunocompetent children are described. Both patients lived in endemic areas for leishmaniasis (Sicily) and at admission were febrile, pale and had splenomegaly. In both patients anti-leishmania antibodies were present and a definitive diagnosis was confirmed by demonstration of leishmania parasites by microscopy or polymerase chain reaction (PCR) in the bone marrow aspirates. The use of PCR performed on peripheral blood has been reported to be highly sensitive for the diagnosis and follow-up of children with VL. One patient was treated with N-dimethylglucamine, Glucantim, the other one with liposomal Amphotericin B (AmBisome). Both had symptomatic relapses 3 months later, and recovered following re-treatment with AmBisome administered intravenously at a dosage of 3 mg/Kg for ten consecutive days. The patients were monitored for one year after treatment was completed