Clinical and Epidemiologic Features of Visceral Leishmaniasis in Children in Southwestern China

Visceral leishmaniasis (VL) is a life-threatening parasitic infection transmitted by phlebotomine sandflies. We undertook this study to analyze the clinical features of pediatric VL in a population of Chinese children.A retrospective study was performed with pediatric patients (≤14 years) diagnosed with VL based on bone marrow biopsy, serology and diagnosis based on clinical manifestation and the improvement after the experimental drug when negative bone marrow and serology results were shown in West China Second Hospital, between January 2001 and December 2015.A total of 43 patients were determined as having a VL infection (ranging from 4 months to 12 years with a slight male preponderance). Sixty-seven percent were less than 5 years of age and 74% of patients resided in endemic regions. The average time to diagnosis from the onset of symptoms was 37.5 days (ranging from 5 days to 6 months). The main clinical manifestations were fever (98%), splenomegaly (98%), hepatomegaly (74%), pancytopenia (72%), pallor (33%), cough (33%) and lymphadenopathy (33%). Hepatic dysfunction was also found in 24 patients (68%). All patients were treated with meglumine antimonite; only 1 child was treated with liposomal amphotericin B after resistance to meglumine antimonite was discovered. Patients were clinically cured except for 1 patient, who died from hemorrhagic shock because of refusal of standard treatment.Although there were no specific clinical manifestations of pediatric VL, a characterization of the overall symptoms may lead to an improved awareness of VL by clinicians and prompt early diagnosis and treatments. Presently, pentavalent antimony remains the first-line drug and there is low resistance in China.