Article
Visceral leishmaniasis in Malta
an 18 year paediatric,
population based study
Victor Grech, Joseph Mizzi, Mariella Mangion, Cecil Vella
Paediatric
Department, St Luke's Hospital Guardamangia, Malta
Correspondence to: Dr Grech email: victor.e.grech{at}magnet.mt
Accepted 27 January
2000
BACKGROUND
Visceral leishmaniasis
(VL) is a chronic parasitic infection that infects approximately
400 000 individuals annually, with a predilection towards early childhood.
AIMSTo study the epidemiology of
VL in childhood.
METHODSVL is endemic in Malta, a
small archipelago of islands in the centre of the Mediterranean with a
total population approaching half a million. Notification of human
cases of leishmaniasis is compulsory. Case records of all 81 paediatric
patients with VL between 1980 and 1998 were analysed.
RESULTSThe annual incidence of VL
declined for all cases of VL, and declined significantly for paediatric
cases (p = 0.01). For 1994 to 1998, the overall incidence of VL was
0.9 per 100 000 total population and the paediatric incidence was 2.5 per 100 000 population. Median age at presentation was 34 months.
Common features at presentation were splenomegaly, hepatomegaly, fever,
and pancytopenia with high lymphocyte and monocyte counts. The
diagnostic sensitivity of isolated immunofluorescent antibody testing
was equivalent to bone marrow aspiration (95%). Blood transfusions for
anaemia were required in 93% of patients. Eleven per cent had
intercurrent infections. All patients were cured, and were initially
treated with intravenous sodium stibogluconate. Defervescence occurred after a median of six days of treatment, and patients continued to be
treated on a day case basis. Nine relapsers were retreated with sodium
stibogluconate, achieving a cure rate of 94%, but five patients
required additional drug therapy. There were no permanent sequelae
associated with VL or its treatment.
CONCLUSIONSThe decreased incidence
is attributed to the eradication of stray dogs which are the disease reservoir.
Keywords: leishmaniasis; epidemiology; antiprotozoal agents; antimony; sodium stibogluconate; retrospective study
© 2000 by Archives of Disease in Childhood
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This article has been cited by other articles:
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Piscopo, T. V, Mallia Azzopardi, C.
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RÉVÉSZ, T, WOLFS, T F W, KARDOS, G, VAN FURTH, A M, GRECH, V
(2001). Visceral leishmaniasis: also beware of these deceptive microbes in non-endemic countries! Dr Grech comments:. Arch. Dis. Child.
84: 373b-373
[Full Text]
eLetters:
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- Visceral leishmaniasis: Beware of these deceptive microbes also in non-endemic countries!
- Tom Revesz
- ADC Online, 30 Aug 2000 [Full text]
- Re: Visceral leishmaniasis: Beware of these deceptive microbes also in non-endemic countries!
- Victor Grech
- ADC Online, 1 Sep 2000 [Full text]
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