Diro Ermias, Lynen Lutgarde, Gebregziabiher Berhane, Assefa Abraham, Lakew Wubishet, Belew Zewdu, Hailu Asrat, Boelaert Marleen, van Griensven Johan
University of Gondar, Gondar, Ethiopia; Institute of Tropical Medicine, Antwerp, Belgium.
Trop Med Int Health. 2015 Jan;20(1):8-16. doi: 10.1111/tmi.12407. Epub 2014 Oct 20.
Visceral leishmaniasis (VL) in north-west Ethiopia is causing an overwhelming case load among adult migrant workers that masked the disease burden in children. This study describes the clinical profile and explores comorbidities in paediatric VL patients.
A prospective study at two hospitals in this region (Gondar and Humera) was conducted in a year period, 2011-2012. The clinical manifestations and comorbidities such as malnutrition, intestinal parasitosis and vitamin D deficiency and HIV infection were assessed, and treatment outcomes noted.
A total of 122 children with VL were detected during the study period with median age of 8.5 years (IQR 5-12 years); 23% were under 5 years. Eighty-five (69.7%) cases were male. The clinical manifestations were similar to the adult patients. High rates of malnutrition, intestinal parasitosis (47.5%) and hypovitaminosis D (56.4%) were detected. The proportion of stunting and wasting was 63% and 22.2% in children aged under five years, and 50.5% and 75.9% in 5-year and older children, respectively, using WHO standard growth curves. Only one child had HIV infection. In 95% of the cases, sodium stibogluconate (20 mg/kg/day for 30 days) was used for treatment. The treatment success rate at end of therapy was 98.3%, but the definitive outcome at 6 months could not be determined because of a high loss to follow-up (80.2%).
While HIV co-infection was rare, malnutrition, intestinal parasitosis and vitamin D deficiency were frequent indicating the need for further research on their role in the pathophysiology. Meanwhile, systematic assessment and management of malnutrition and intestinal parasitosis in VL programmes is recommended.
在埃塞俄比亚西北部，内脏利什曼病（VL）在成年流动工人中导致了大量病例，掩盖了儿童的疾病负担。本研究描述了儿科VL患者的临床特征并探讨了其合并症。
2011年至2012年期间，在该地区的两家医院（贡德尔和胡梅拉）进行了一项前瞻性研究。评估了临床表现和合并症，如营养不良、肠道寄生虫病、维生素D缺乏和HIV感染，并记录了治疗结果。
在研究期间共检测到122例儿童VL患者，中位年龄为8.5岁（四分位间距5 - 12岁）；23%的患者年龄在5岁以下。85例（69.7%）为男性。临床表现与成年患者相似。检测到高比例的营养不良、肠道寄生虫病（47.5%）和维生素D缺乏症（56.4%）。根据世界卫生组织标准生长曲线，5岁以下儿童发育迟缓率和消瘦率分别为63%和22.2%，5岁及以上儿童分别为50.5%和75.9%。仅1例儿童感染HIV。95%的病例使用葡萄糖酸锑钠（20mg/kg/天，共30天）进行治疗。治疗结束时的治疗成功率为98.3%，但由于随访失访率高（80.2%），无法确定6个月时的最终结局。
虽然HIV合并感染罕见，但营养不良、肠道寄生虫病和维生素D缺乏常见，这表明需要进一步研究它们在病理生理学中的作用。同时，建议在VL项目中对营养不良和肠道寄生虫病进行系统评估和管理。
