Clinical Report: Pediatric Visceral Leishmaniasis in France – Diagnosis and Treatment Insights
Overview
This retrospective French study analyzed 63 pediatric visceral leishmaniasis (VL) cases over a decade, highlighting diagnostic delays, frequent hemophagocytic lymphohistiocytosis (HLH), and varied liposomal amphotericin B treatment regimens. Combined blood and bone marrow PCR testing optimized diagnosis, with all patients ultimately recovering despite some relapses.
Background
Visceral leishmaniasis (VL) is a neglected tropical disease caused by Leishmania parasites transmitted by sandflies, with an estimated 50,000 new cases annually worldwide. In mainland France, VL is rare but endemic in the Mediterranean region, predominantly affecting immunocompromised individuals and young children. Pediatric VL diagnosis is challenging due to atypical presentations and delayed recognition, complicating management. This study retrospectively assessed clinical features, diagnostic methods, and treatment outcomes in children hospitalized with VL across French university hospitals from 2012 to 2022.
Data Highlights
Parameter
Value
Number of patients
63
Median age (years)
2 (IQR 1–5.4)
Male/Female ratio
1.25
Median diagnostic delay (days)
20 (IQR 11.7–35.2)
Fever prevalence
92%
Splenomegaly prevalence
78%
Inflammatory syndrome prevalence
90%
Pancytopenia prevalence
79%
Hepatic cytolysis prevalence
52%
HLH prevalence
44%
Bone marrow smear positivity
64%
Bone marrow qPCR positivity
90%
Blood qPCR positivity
96%
Combined blood and bone marrow PCR positivity
100%
Relapse rate
6.3%
Key Findings
Pediatric VL in France is rare but predominantly affects very young children with a median age of 2 years.
Diagnostic delays are common, with a median of 20 days from symptom onset to diagnosis.
Fever and splenomegaly are the most frequent clinical signs; HLH complicates nearly half of cases.
Blood and bone marrow qPCR testing combined yields a 100% diagnostic positivity rate, outperforming bone marrow smear alone.
Liposomal amphotericin B was used in all cases with varied dosing regimens; despite this, all children recovered.
Relapses occurred in 6.3% of patients, underscoring the need for standardized treatment and follow-up protocols.
Clinical Implications
Clinicians should maintain a high index of suspicion for VL in children presenting with prolonged fever and splenomegaly, especially in endemic areas. Utilizing combined blood and bone marrow PCR testing can significantly improve diagnostic accuracy. Standardizing liposomal amphotericin B treatment regimens and establishing consistent follow-up protocols are essential to optimize outcomes and reduce relapse rates.
Conclusion
Pediatric visceral leishmaniasis in France remains a rare but serious condition characterized by diagnostic delays and frequent HLH. Enhanced diagnostic strategies and standardized treatment approaches are critical to improving patient outcomes.
References
Mary et al 2004 -- Real-time PCR for Leishmania diagnosis
French National Reference Center for Leishmaniasis 1998-2020 data
by Justine de Larminat, Naïma Dahane, Nicolas Argy, Mahmoud Rifai, Olivier Haas Ferrua, Christelle Pomares, Nicolas Rasandisona Ravonjena, Damien Dupont, Jean-Philippe Lemoine, Sarah Dutron, Olivia Pineau, Philippe Picherit Steinbrucker, Thibault César, Séhomi Azohana, Sophie Guilmin-Crepon, Philippe Minodier, Irina Allouche, Mathie Lorrot, Christophe Ravel, Albert Faye
