Background Little information is available about infantile visceral leishmaniasis (VL) in Albania as regards incidence, diagnosis and management of the disease. Methodology/Principal Findings Demographic data, clinical and laboratory features and therapeutic findings were considered in children admitted to University Hospital of Tirana from 1995 to 2009, and diagnosed as having VL. The diagnosis was based on bone-marrow microscopy/culture in 77.5% of patients, serology in 16.1%, and ex juvantibus in 6.4%. A total of 1,210 children were considered, of whom 74% came from urbanized areas. All patients were in the age range 0–14 years, with a median of 4 years. Hepatosplenomegaly was recorded in 100%, fever in 95.4% and moderate to severe anemia in 88% of cases. Concomitant conditions were frequent: 84% had bronchopneumonia; diarrhea was present in 27%, with acute manifestations in 5%; 3% had salmonellosis. First-line therapy was meglumine antimoniate for all patients, given at the standard Sbv dosage of 20 mg/kg/day for 21 to 28 days. Two children died under treatment, one of sepsis, the other of acute renal impairment. There were no cases of primary unresponsiveness to treatment, and only 8 (0.67%) relapsed within 6–12 months after therapy. These patients have been re-treated with liposomal amphotericin B, with successful cure. Conclusions Visceral leishmaniasis in pediatric age is relatively frequent in Albania; therefore an improvement is warranted of a disease-specific surveillance system in this country, especially as regards diagnosis. Despite recent reports on decreased responses to antimonial drugs of patients with Mediterranean VL, meglumine antimoniate treatment appears to be still highly effective in Albania.
References
[1]
Gramiccia M, Gradoni L (2005) The current status of zoonotic leishmaniases and approaches to disease control. Int J Parasitol 35: 1169–1180. doi: 10.1016/j.ijpara.2005.07.001
[2]
Dujardin JC, Campino L, Ca？avate C, Dedet JP, Gradoni L, et al. (2008) Spread of vector-borne diseases and neglect of leishmaniasis, Europe. Emerg Infect Dis 14: 1013–1018. doi: 10.3201/eid1407.071589
[3]
Le Fichoux Y, Quaranta JF, Aufeuvre JP, Lelievre A, Marty P, et al. (1999) Occurrence of Leishmania infantum parasitemia in asymptomatic blood donors living in an area of endemicity in southern France. J Clin Microbiol 37: 1953–1957.
[4]
Colomba C, Saporito L, Vitale F, Reale S, Vitale G, et al. (2009) Cryptic Leishmania infantum infection in Italian HIV infected patients. BMC Infect Dis 9: 199. doi: 10.1186/1471-2334-9-199
[5]
Biglino A, Bolla C, Concialdi E, Trisciuoglio A, Romano A, et al. (2010) Asymptomatic Leishmania infantum infection in an area of northwestern Italy (Piedmont Region) where such infections are traditionally nonendemic. J Clin Microbiol 48: 131–136. doi: 10.1128/JCM.00416-09
[6]
Alvar J, Aparicio P, Aseffa A, Den Boer M, Can？vate C, et al. (2008) The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev 21: 334–359. doi: 10.1128/CMR.00061-07
[7]
Basset D, Faraut F, Marty P, Dereure J, Rosenthal E, et al. (2005) Visceral leishmaniasis in organ transplant recipients: 11 new cases and a review of the literature. Microb Infect 7: 1370–1375. doi: 10.1016/j.micinf.2005.06.002
Velo E, Bino S, Kuli-Lito G, Pano K, Gradoni L, et al. (2003) Recrudescence of visceral leishmaniasis in Albania: retrospective analysis of cases during 1997 to 2001 and results of an entomological survery carried out during 2001 in some districts. Trans R Soc Trop Med Hyg 97: 288–290. doi: 10.1016/S0035-9203(03)90145-3
[10]
Bern C, Adler-Moore J, Berenguer J, Boelaert M, Den Boer M, et al. (2006) Liposomal amphotericin B in the treatment of visceral leishmaniasis. Clin Infect Dis 43: 917–924. doi: 10.1086/507530
[11]
Chappuis F, Sundar S, Hailu A, Ghalib H, Rijal S, et al. (2007) Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol 5: 873–882. doi: 10.1038/nrmicro1748
[12]
Desjeux P (2001) The increase in risk factors for leishmaniasis worldwide. Trans R Soc Trop Med Hyg 95: 239–243. doi: 10.1016/S0035-9203(01)90223-8
[13]
Alvar J, Yactayo S, Bern C (2006) Leishmaniasis and poverty. Trends Parasitol 22: 552–557. doi: 10.1016/j.pt.2006.09.004
[14]
Maltezou HC, Siafas C, Mavrikou M, Spyridis P, Stavrinadis C, et al. (2000) Visceral leishmaniasis during childhood in southern Greece. Clin Infect Dis 31: 1139–43. doi: 10.1086/317455
[15]
Pagliano P, Rossi M, Rescigno C, Altieri S, Coppola MG, et al. (2003) Mediterranean visceral leishmaniasis in HIV-negative adults: a retrospective analysis of 64 consecutive cases (1995–2001). J Antimicrob Chemother 52: 264–268. doi: 10.1093/jac/dkg340
[16]
Cascio A, di Martino L, Occorsio P, Giacchino R, Catania S, et al. (2004) A six-day course liposomal amphotericin B in the treatment of infantile visceral leishmaniasis: the Italian experience. J Antimicrob Chemother 54: 217–220. doi: 10.1093/jac/dkh279
[17]
Scarlata F, Vitale F, Saporito L, Reale S, Vecchi VL, et al. (2008) Asymptomatic Leishmania infantum/chagasi infection in blood donors of western Sicily. Trans R Soc Trop Med Hyg 102: 394–396. doi: 10.1016/j.trstmh.2008.01.011
[18]
Diza E, Kansouzidou A, Gerou S, Vezyri E, Metallidis S, et al. (2008) Leishmaniases in Northern Greece: seroprevalence of the infection and incidence of the disease during the period 2001–2006. Eur J Clin Microbiol Infect Dis 27: 997–1003. doi: 10.1007/s10096-008-0538-y
[19]
Cascio A, Colomba C, Antinori S, Orobello M, Paterson D, et al. (2002) Pediatric visceral leishmaniasis in Western Sicily, Italy: a retrospective analysis of 111 cases. Eur J Clin Microbiol Infect Dis 21: 277–282. doi: 10.1007/s10096-002-0707-3
[20]
Laguna F, Videla S, Jimenéz-Mejías ME, Sirera G, Torre-Cisneros J, et al. (2003) Amphotericin B lipid complex versus meglumine antimoniate in the treatment of visceral leishmaniasis in patients infected with HIV: a randomized pilot study. J Antimicrob Chemother 52: 464–468. doi: 10.1093/jac/dkg356
[21]
Gradoni L, Soteriadou K, Louzir H, Dakkak A, Ozensoy Toz S, et al. (2008) Drug regimens for visceral leishmaniasis in Mediterranean countries. Trop Med Int Health 13: 1272–1276. doi: 10.1111/j.1365-3156.2008.02144.x
[22]
Gradoni L, Gramiccia M, Scalone A (2003) Visceral leishmaniasis treatment, Italy. Emerg Infect Dis 9: 1617–1620. doi: 10.3201/eid0912.030178
