0
November 1991, Vol 145, No. 11 >
Article | November 1991

Mediterranean Visceral Leishmaniasis: A Frequently Unrecognized Imported Disease FREE

LUDO M. MAHIEU, MD; KAREL J. VAN ACKER, MD, PHD
Am J Dis Child. 1991;145(11):1225-1227. doi:10.1001/archpedi.1991.02160110015008.
Text Size: A A A
Published online
Article
References
Comments

Sir.—Visceral leishmaniasis is endemic in countries surrounding the Mediterranean Sea. With mass tourism, nonresidents returning from this area are now also increasingly affected.1,2 However, it appears from the literature that this diagnosis is often not considered in these patients, that numerous unnecessary investigations are performed, and that appropriate treatment of this potentially fatal infection is delayed or withheld.3 This is clearly illustrated by the following report.

Patient Report.—A 10-month-old boy was referred to our department because of a persistent spiking fever of 3 weeks' duration that had not responded to oral treatment with amoxicillin and cefadroxil. Clinical investigation on admission revealed a fever of 40°C, marked hepatosplenomegaly, paleness, and slightly enlarged inguinal lymph nodes. Abnormal results of laboratory investigation were severe hypochromic anemia, leukopenia with neutropenia, thrombocytopenia, increased C-reactive protein levels, and positive results of a direct Coombs' test (Table). Roentgenograms of the chest and results

REFERENCES

1 +
Russo A, Russo Mancuso G, Battaglini CM, Schiliro G.  Leishmaniasis, a worldwide disease . Lancet . 1986;;1:451-452.
2 +
Filser TH, Heim ME, Kollmeier W, Heene DL.  Visceral leishmaniasis in Europe . Practitioner . 1982;;226:1559-1564.
3 +
Gottstein U, Steiner K, Hauk H, Klimaschewski G, Sedlmeyer I.  Kala-Azar (viszerale Leishmaniose)—eine wichtige Krankheit nicht nur der Tropen . Dtsch Med Wochenschr . 1975;;100:2022-2027.
4 +
Li Volti S, Fischer A, Musumeci S.  Hematological and serological aspects of Mediterranean kala-azar in infancy and childhood . Acta Trop . 1980;;37:351-365.
5 +
Boel M, Gunawan J, Gillis F, et al.  An unusual case of hepatosplenomegaly . Acta Paediatr Belg . 1981;;34:97-102.
6 +
Hill FGH, Letsky EA.  Infantile kalaazar in Britain . BMJ . 1975;;2:354-355.
7 +
Galvao-Castro B, Ferreira JA, Marzochi KF, Marzochi MC, Coutinho SG, Lambert PH.  Polyclonal B cell activation, circulating immune complexes and autoimmunity in human American visceral leishmaniasis . Clin Exp Immunol . 1984;; 56:58-66.
8 +
Böhme MW, Evans DA, Miles MA, Holborow EJ.  Occurrence of autoantibodies to intermediate filament proteins in human visceral leishmaniasis and their induction by experimental polyclonal B-cell activation . Immunology . 1986;;59:583-588.
9 +
Van de List-Nuver CJ, Sjamsoedin-Visser EJ, Hendrickx GF, Zegers BJ.  Een patient met een vergrote lever en milt en piekende temperatuur . Ned Tijdschr Ceneeskd . 1979;;123:817-821.
10 +
Heilmann K, Döhnert G, Wohlenberg H.  Tödlich verlaufende Leishmaniasis visceralis (Kala Azar) bei Mittelmeerurlaubern . Dtsch Med Wochenschr . 1971;;96:36-38.
11 +
Van der Linde DL, Meuwissen OJ, Van Gorp LHM.  Kala-Azar in Nederland . Ned Tijdschr Geneeskd . 1969;;113:1413-1418.
12 +
Ornvold K, Carstensen H, Magnussen P, Nielsen MH, Pedersen FK.  Kala-azar in a four-year-old child 18 months after brief exposure in Malta . Acta Paediatr Scand . 1989;;78:650-652.
13 +
Baldus M, Schleiffer T, Brass H.  Viszerale Leishmaniose (Kala-Azar): Eine seltene Differentialdiagnose bei Splenomegalie und Panzytopenie . Dtsch Med Wochenschr . 1989;;114:1876-1881.
14 +
Boon DA, De Nef JJE, Kager PA.  Crote milt, grote problemen . Tijdschr Kindergeneeskd . 1985;; 53:224-227.
15 +
Ridley DS.  The laboratory diagnosis of tropical diseases with special reference to Britain: a review . J Clin Pathol . 1974;;27:435-444.
16 +
Berman JD.  Chemotherapy for leishmaniasis: biochemical mechanisms, clinical efficacy and future strategies . Rev Infect Dis . 1988;;10:560-586.
17 +
Rees PH, Kager PA, Kyambi JM, Ayim EN, Bhatt KM.  Splenectomy in kala azar . Trop Ceogr Med . 1984;; 36:285-292.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Russo A, Russo Mancuso G, Battaglini CM, Schiliro G.  Leishmaniasis, a worldwide disease . Lancet . 1986;;1:451-452.
2 +
Filser TH, Heim ME, Kollmeier W, Heene DL.  Visceral leishmaniasis in Europe . Practitioner . 1982;;226:1559-1564.
3 +
Gottstein U, Steiner K, Hauk H, Klimaschewski G, Sedlmeyer I.  Kala-Azar (viszerale Leishmaniose)—eine wichtige Krankheit nicht nur der Tropen . Dtsch Med Wochenschr . 1975;;100:2022-2027.
4 +
Li Volti S, Fischer A, Musumeci S.  Hematological and serological aspects of Mediterranean kala-azar in infancy and childhood . Acta Trop . 1980;;37:351-365.
5 +
Boel M, Gunawan J, Gillis F, et al.  An unusual case of hepatosplenomegaly . Acta Paediatr Belg . 1981;;34:97-102.
6 +
Hill FGH, Letsky EA.  Infantile kalaazar in Britain . BMJ . 1975;;2:354-355.
7 +
Galvao-Castro B, Ferreira JA, Marzochi KF, Marzochi MC, Coutinho SG, Lambert PH.  Polyclonal B cell activation, circulating immune complexes and autoimmunity in human American visceral leishmaniasis . Clin Exp Immunol . 1984;; 56:58-66.
8 +
Böhme MW, Evans DA, Miles MA, Holborow EJ.  Occurrence of autoantibodies to intermediate filament proteins in human visceral leishmaniasis and their induction by experimental polyclonal B-cell activation . Immunology . 1986;;59:583-588.
9 +
Van de List-Nuver CJ, Sjamsoedin-Visser EJ, Hendrickx GF, Zegers BJ.  Een patient met een vergrote lever en milt en piekende temperatuur . Ned Tijdschr Ceneeskd . 1979;;123:817-821.
10 +
Heilmann K, Döhnert G, Wohlenberg H.  Tödlich verlaufende Leishmaniasis visceralis (Kala Azar) bei Mittelmeerurlaubern . Dtsch Med Wochenschr . 1971;;96:36-38.
11 +
Van der Linde DL, Meuwissen OJ, Van Gorp LHM.  Kala-Azar in Nederland . Ned Tijdschr Geneeskd . 1969;;113:1413-1418.
12 +
Ornvold K, Carstensen H, Magnussen P, Nielsen MH, Pedersen FK.  Kala-azar in a four-year-old child 18 months after brief exposure in Malta . Acta Paediatr Scand . 1989;;78:650-652.
13 +
Baldus M, Schleiffer T, Brass H.  Viszerale Leishmaniose (Kala-Azar): Eine seltene Differentialdiagnose bei Splenomegalie und Panzytopenie . Dtsch Med Wochenschr . 1989;;114:1876-1881.
14 +
Boon DA, De Nef JJE, Kager PA.  Crote milt, grote problemen . Tijdschr Kindergeneeskd . 1985;; 53:224-227.
15 +
Ridley DS.  The laboratory diagnosis of tropical diseases with special reference to Britain: a review . J Clin Pathol . 1974;;27:435-444.
16 +
Berman JD.  Chemotherapy for leishmaniasis: biochemical mechanisms, clinical efficacy and future strategies . Rev Infect Dis . 1988;;10:560-586.
17 +
Rees PH, Kager PA, Kyambi JM, Ayim EN, Bhatt KM.  Splenectomy in kala azar . Trop Ceogr Med . 1984;; 36:285-292.

Correspondence

Submit a Letter
CME
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Clear Answers | Save For Later
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2013 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems