Naufal Spir Patricia Rodrigues, Prestes-Carneiro Luiz Euribel, Fonseca Elivelton Silva, Dayse Aline, Giuffrida Rogério, D'Andrea Lourdes Aparecida Zampieri
a Department of Pediatrics , Regional Hospital , Presidente Prudente , Brazil.
b Department of Immunology and Infectious Diseases , University of Oeste Paulista , Presidente Prudente , Brazil.
Pathog Glob Health. 2017 Mar;111(2):91-97. doi: 10.1080/20477724.2017.1289666. Epub 2017 Feb 21.
Visceral leishmaniasis (VL) is an emerging zoonosis, and Brazil harbors about 90% of those infected in Latin America. Since 1998, the disease has been spreading quickly in São Paulo state, and the western region is considered an emerging focus of VL in Brazil. Our aim was to evaluate the clinical characteristics and spatial distribution of VL in children referred to a public tertiary hospital located in the western region of São Paulo state, Brazil.
Medical records of children up to 18 years of age who were diagnosed with VL between January 2006 and December 2010 were reviewed. Geospatial analysis was performed using the ArcGIS 10.2 platform.
Sixty-three patients were enrolled in the study; the median age was 3.3 ± 3.3 years. The median time interval between the onset of clinical symptoms and diagnosis was 16.1 ± 11.1 days, and the median time in the pediatric ward was 18.0 ± 9.4 days. Liposomal amphotericin B was the first-line treatment in 90.5% of the patients and 9.6% relapsed. One patient died (1.6%), and 19% were submitted to the pediatric intensive care unit.
The short interval between the onset of symptoms, diagnosis, and treatment and the reduced number of days of hospitalization certainly influenced the small number of deaths, relapses, and severity among the children infected with VL. However, the disease is spreading fast in the western region of São Paulo state. Thus, integrated actions and effective monitoring of the disease are needed to complement curative practices.
内脏利什曼病（VL）是一种新发人畜共患病，巴西的感染病例占拉丁美洲的90%左右。自1998年以来，该病在圣保罗州迅速蔓延，西部地区被认为是巴西VL的一个新发病灶。我们的目的是评估转诊至巴西圣保罗州西部地区一家公立三级医院的儿童VL的临床特征和空间分布。
回顾了2006年1月至2010年12月期间诊断为VL的18岁以下儿童的病历。使用ArcGIS 10.2平台进行地理空间分析。
63例患者纳入研究；中位年龄为3.3±3.3岁。临床症状出现至诊断的中位时间间隔为16.1±11.1天，在儿科病房的中位住院时间为18.0±9.4天。90.5%的患者以脂质体两性霉素B作为一线治疗，9.6%的患者复发。1例患者死亡（1.6%），19%的患者入住儿科重症监护病房。
症状出现、诊断和治疗之间的间隔时间短以及住院天数减少，肯定影响了感染VL儿童的死亡、复发和严重程度数量较少。然而，该病在圣保罗州西部地区正在迅速蔓延。因此，需要采取综合行动并对该病进行有效监测，以补充治疗措施。
