DIAGNOSTIC AND MANAGEMENT PROBLEMS IN CHILDHOOD VISCERAL LEISHMANIASIS IN SOUTH-WESTERN SAUDI-ARABIA

The diagnosis and management of childhood visceral leishmaniasis were studied in 51 parasitologically proven cases from Abha, Saudi Arabia. Bone marrow aspiration was positive in 40 of 47 cases (85%). Splenic a spiration, though rarely used because of perceived dangers, was not as sociated with complications and revealed the parasite in all 12 cases in which it was used. There was prompt response to sodium stiboglucona te, with defervescence in 93% and decrease of hepatosplenomegaly in 67 % of patients within 1 week of commencing chemotherapy. A dose of 20 m g/kg/day for at least 3 weeks was generally safe and effective in achi eving cure and preventing relapse. Two children with persistent massiv e splenomegaly after the first course responded to prolonged chemother apy. Bronchopneumonia and severe cytopenia were common complications. Disseminated intravascular coagulation and hepatitis were associated w ith a poor outcome. The four patients who died had a progressive cours e with multiple complications. Early detection and appropriate managem ent of complications may help to reduce morbidity and mortality in chi ldhood visceral leishmaniasis.