Visceral Leishmaniasis in children in the Yemen

OBJECTIVE: The clinical presentation and duration of therapy for visceral leishmaniasis varies in different countries. The sodium stibogluconate is costly, and a trial of short course therapy has not yet been studied in Hajjah governorate. The aim of this study was to evaluate the efficacy of a 20 days regimen of sodium stibogluconate and to ascertain the epidemiological, clinical and laboratory features of visceral leishmaniasis in children.

METHODS: This was a prospective hospital-based study in Hajjah Governorate, Republic of Yemen. Children of 12 years of age or less with a confirmed diagnosis were included. Sodium stibogluconate was given in a dose of 15mg/kg/dose daily for 20 days, then the patients were re-evaluated and the data required for achieving the other objective was collected.

RESULTS: Thirty-two patients fulfilled the inclusion criteria. The age ranged from 12 months to 144 months (67.7 ± 35). Females formed 53% of this criteria. The duration of symptoms ranged from 2 weeks to 116 weeks. Fever, fatigability and abdominal distension were the most common symptoms. The hematological findings showed anemia in all patients, leukopenia in 81% and thrombocytopenia in 56%. Formol gel test was negative in 20 patients (63%). Malaria smear was positive in 11 patients (34%). Splenic aspiration was carried out in 25 patients (78%) and bone marrow aspiration in 7 patients (22%). Blood transfusion were required for 24 patients (73%). After 20 days treatment with pentostam, 20 patients (63%) came for follow-up and re-tested for parasitological cure. Half of those were still positive for leishmania donovan bodies. The mortality rate was 5%.

CONCLUSION: The clinical features were of the Mediterranean type. Twenty days treatment with sodium stibogluconate was not adequate.