Infantile visceral leishmaniasis: about 209 cases

Infantile visceral leishmaniasis (IVL), or Kala Azar, is a parasitic disease caused by the proliferation of a protozoan parasite Leishmania in the reticulo-histiocyte system. It is characterized by its geographical distribution most frequently in the Mediterranean area, India, East Africa and South America. In Morocco, during these last years, we are witnessing a significant recrudescence mainly in young child. The authors performed a retrospective study of 209 cases of visceral leishmaniasis admitted to the service of pediatrics at the University Hospital of Fez (CHU Hassan II) during a six-year period from January 1998 to December 2004. The average age of our patients is 3.7 years and boys are more affected (sex-ratio = 1.45) 90% of the cases come from the suburbs of Fez, primarily from Taounate. The average time of consultation is 2.26 months. The main reasons are abdominal distension (68%), fever (94.5%) and the paleness (50%); rarely a hemorrhagic syndrome (8.5%). The clinical examination shows anaemia in 90% of the cases, fever in 92.6% of the cases and splenomegaly in 97.66% of the cases. The diagnosis is confirmed by the myelogram and the serology of leishmaniasis in 91.3% of the cases. Average diagnosis time is eight days. The identification of the parasite is achieved in collaboration with the Pasteur Institute of Casablanca and Leishmania infantum zymodeme-1 is detected in 100% of the cases. The treatment is based on glucantime at the dose of 80 to 100 mg/kg per day during 21 to 30 days and is efficient in 95.57% of the cases. We deplored six deaths which occurred due to malnutrition and probably in association with a macrophage activation syndrome. Infantile visceral leishmaniasis is the most frequent zoonosis in Morocco. Fez and its suburbs are an area of high endemicity. Its eradication must initially be based on improving socioeconomic conditions as well as fighting against malnutrition, which is a risk factor. © 2007 Elsevier Masson SAS. All rights reserved.