Pediatric Department, University Hospital Center Mother Theresa, Tirana, Albania.
PLoS Negl Trop Dis. 2010 Sep 7;4(9):e814. doi: 10.1371/journal.pntd.0000814.
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 Sb(v) 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.
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.
在阿尔巴尼亚，有关婴儿内脏利什曼病（VL）的发病率、诊断和治疗方法的信息很少。
方法/主要发现：从 1995 年至 2009 年，在都拉斯大学医院就诊并被诊断为 VL 的儿童中，考虑了人口统计学数据、临床和实验室特征以及治疗发现。诊断依据为骨髓显微镜检查/培养（77.5%的患者）、血清学检查（16.1%）和治疗效果检查（6.4%）。共考虑了 1210 名儿童，其中 74%来自城市化地区。所有患者的年龄均在 0-14 岁之间，中位数为 4 岁。100%的患者存在肝脾肿大，95.4%的患者有发热，88%的患者有中重度贫血。同时存在的疾病很常见：84%的患者有支气管肺炎；腹泻发生率为 27%，急性腹泻发生率为 5%；3%的患者有沙门氏菌病。所有患者均采用葡萄糖酸锑钠进行一线治疗，标准 Sb（v）剂量为 20mg/kg/天，疗程为 21-28 天。有 2 名患儿在治疗过程中死亡，1 例死于败血症，另 1 例死于急性肾功能不全。无原发性治疗无应答病例，仅 8 例（0.67%）在治疗后 6-12 个月内复发。这些患者用脂质体两性霉素 B 进行了再治疗，获得了成功治愈。
在阿尔巴尼亚，儿科内脏利什曼病相对常见；因此，该国需要改进针对该疾病的监测系统，特别是在诊断方面。尽管最近有报道称地中海型 VL 患者对锑剂的反应降低，但葡萄糖酸锑钠治疗在阿尔巴尼亚似乎仍然非常有效。
