Diagnosis and Management of Visceral Leishmaniasis in Children: A French Retrospective Study
Clinical Scorecard: Evaluation and Treatment Approaches for Pediatric Visceral Leishmaniasis: Insights from a French Retrospective Analysis
At a Glance
Category Detail
Condition Pediatric Visceral Leishmaniasis (VL) Key Mechanisms Infection by Leishmania sp. protozoan parasite transmitted by female sandfly bites causing systemic disease with fever, splenomegaly, pancytopenia, and inflammatory syndrome Target Population Children under 18 years, median age 2 years, primarily in endemic areas including southern France Care Setting University hospitals in mainland France
Key Highlights
Median diagnostic delay was 20 days with common symptoms including fever (92%) and splenomegaly (78%). High frequency (44%) of hemophagocytic lymphohistiocytosis (HLH) complicating pediatric VL cases. Combined blood and bone marrow PCR testing achieved 100% positivity, optimizing diagnosis. Guideline-Based Recommendations
Diagnosis
Use bone marrow smear microscopy and Leishmania real-time PCR (qPCR) in blood and bone marrow for confirmation. Combine blood and bone marrow PCR to maximize diagnostic sensitivity. Serology by ELISA and Western Blot can support diagnosis but PCR is preferred. Management
Treat all confirmed pediatric VL cases with liposomal amphotericin B. Dosing regimens varied between 18 to 30 mg/kg cumulative dose over 2 to 8 days. Standardization of therapeutic regimens is necessary to optimize outcomes. Monitoring & Follow-up
Follow-up median duration was 2.8 months to monitor for relapse. Monitor clinical recovery and laboratory parameters including cytopenias and inflammatory markers. Risks
Delayed diagnosis can lead to complications including HLH. Relapse occurred in 6.3% of patients, highlighting need for careful follow-up. Variability in treatment regimens may impact relapse risk. Patient & Prescribing Data
63 pediatric patients diagnosed with VL in French university hospitals from 2012 to 2022
All patients received liposomal amphotericin B with variable dosing regimens; all recovered with 4 relapses reported, one untreated
Clinical Best Practices
Consider VL in children with prolonged fever and splenomegaly in endemic areas. Employ combined blood and bone marrow PCR testing to improve diagnostic accuracy. Initiate prompt treatment with liposomal amphotericin B upon diagnosis. Monitor patients closely for HLH and relapse during follow-up. Advocate for standardized treatment protocols and follow-up schedules. References
