Bhattacharya S K, Sur Dipika, Karbwang Juntra
Rajendra Memorial Research Institute of Medical Sciences,(ICMR), Patna , India.
Indian J Med Res. 2006 Mar;123(3):353-6.
Visceral leishmaniasis (VL) is caused by the protozoan parasite Leishmania donovani and transmitted by the bite of infected sandfly Phlebotomus argentipes. Nearly half of the VL cases occur in children (childhood or paediatric VL). The clinical manifestations of childhood VL are more or less same as in the adults. Prolonged fever with anorexia and loss of appetite are the major presenting features. Marked enlargement of the spleen and liver (spleen larger than liver) with moderate to severe anaemia and changes in hair take place. Bacterial infection is a common coinfection and intestinal parasitic infestations are very common in children with VL. Liver function tests, blood, urine and stool may show abnormalities. Confirmation of diagnosis is made by demonstration of parasite by microscopic examination and culture of materials obtained by bone marrow aspiration or splenic puncture. Sodium antimony gluconate (stibogluconate) has been the drug of choice for over past 50 yr. Pentamidine isothionate, though effective is relatively toxic. Amphotericin B is the most effective drug for the treatment of VL. Miltefosine is the first-ever oral drug, is highly effective. Post kala-azar dermal leishmaniasis (PKDL) in children poses a therapeutic challenge. In the absence of an ideal vaccine for VL, control measures would essentially include prevention of transmission through vector control and community awareness.
内脏利什曼病（VL）由原生动物寄生虫杜氏利什曼原虫引起，通过感染的白蛉银足白蛉叮咬传播。近一半的VL病例发生在儿童中（儿童期或小儿VL）。儿童VL的临床表现与成人基本相同。长期发热伴厌食和食欲不振是主要的表现特征。脾脏和肝脏明显肿大（脾脏大于肝脏），伴有中度至重度贫血和毛发变化。细菌感染是常见的合并感染，肠道寄生虫感染在VL患儿中非常普遍。肝功能检查、血液、尿液和粪便可能显示异常。通过显微镜检查和对骨髓穿刺或脾穿刺获取的材料进行培养来证明寄生虫，从而确诊。过去50多年来，葡萄糖酸锑钠一直是首选药物。喷他脒虽然有效，但毒性相对较大。两性霉素B是治疗VL最有效的药物。米替福新是首个口服药物，疗效显著。儿童黑热病后皮肤利什曼病（PKDL）带来了治疗挑战。由于缺乏针对VL的理想疫苗，控制措施主要包括通过病媒控制和提高社区意识来预防传播。
