Pastorino Antonio C, Jacob Cristina M A, Oselka Gabriel W, Carneiro-Sampaio Magda M S
Dep de Pediatria, Universidade de São Paulo, São Paulo, SP.
J Pediatr (Rio J). 2002 Mar-Apr;78(2):120-7.
To compare the clinical and laboratorial data before and after the treatment of patients with visceral leishmaniasis admitted to a pediatric hospital in a nonendemic area, highlighting the importance of recognizing visceral leishmaniasis in pediatric patients.
Clinical, laboratorial and treatment data of 78 patients with visceral leishmaniasis were evaluated from 1981 to 1992. We analyzed the average level of hemoglobin, leukocyte, neutrophil, platelet, albumin, gammaglobulin, class and subclass of immunoglobulin, size of the liver and spleen during the pre- and post-treatment using the paired t test.
We included 78 patients with visceral leishmaniasis, 44 males, with age ranging from 8 months to 13.5 years. Sixty-one patients were from Bahia. Fever and splenomegaly were present in 96.1% and 100% of the cases, respectively. The parasitological diagnosis was obtained in 74/78 patients: 67 patients through smear and/or culture of bone marrow (85.7%), five through liver biopsy and two through spleen puncture. The hematological findings and serum albumin presented significant improvement at the end of treatment (P<0.001), differently from serum gammaglobulin levels (P=0.087). There was predominance of IgG1 subclass, with two patients presenting low levels of IgG2. Initial treatment used antimoniate in 67 cases and amphotericin B in five. Eleven patients (15.7%) needed a second treatment, and were considered cured after it. There was significant improvement in the liver and spleen size at the end of the treatment (P<0.001). One patient presented spontaneous remission and five died due to bleeding.
In order to obtain accurate diagnosis and treatment, especially regarding health services of areas with low-incidence of visceral leishmaniasis, the diagnosis of patients with fever and visceromegaly, who come from endemic areas, should include visceral leishmaniasis.
比较非流行地区一家儿科医院收治的内脏利什曼病患者治疗前后的临床和实验室数据，强调认识小儿内脏利什曼病的重要性。
评估1981年至1992年78例内脏利什曼病患者的临床、实验室和治疗数据。我们使用配对t检验分析了治疗前和治疗后血红蛋白、白细胞、中性粒细胞、血小板、白蛋白、γ球蛋白、免疫球蛋白类别和亚类、肝脏和脾脏大小的平均水平。
我们纳入了78例内脏利什曼病患者，其中44例为男性，年龄从8个月至13.5岁。61例患者来自巴伊亚州。分别有96.1%和100%的病例出现发热和脾肿大。74/78例患者获得了寄生虫学诊断：67例通过骨髓涂片和/或培养（85.7%），5例通过肝活检，2例通过脾穿刺。治疗结束时血液学检查结果和血清白蛋白有显著改善（P<0.001），与血清γ球蛋白水平不同（P=0.087）。以IgG1亚类为主，2例患者IgG2水平较低。初始治疗67例使用锑剂，5例使用两性霉素B。11例患者（15.7%）需要二次治疗，二次治疗后被视为治愈。治疗结束时肝脏和脾脏大小有显著改善（P<0.001）。1例患者自发缓解，5例死于出血。
为了获得准确的诊断和治疗，特别是在内脏利什曼病低发病率地区的卫生服务方面，对于来自流行地区且有发热和内脏肿大的患者，诊断应包括内脏利什曼病。
