Visceral leishmaniasis in Malta - an 18 year paediatric, population based study

Background-Visceral leishmaniasis (VL) is a chronic parasitic infection tha t infects approximately 400 000 individuals annually, with a predilection t owards early childhood. Aims-To study the epidemiology of VL in childhood. Methods-VL is endemic in Malta, a small. archipelago of islands in the cent re of the Mediterranean with a total population approaching half a million. Notification of human cases of leishmaniasis is compulsory. Case records o f all 81 paediatric patients with VL between 1980 and 1998 were analysed. Results-The annual incidence of VL declined for all cases of VL, and declin ed significantly for paediatric cases (p = 0.01). For 1994 to 1998, the ove rall incidence of VL was 0.9 per 100 000 total population and the paediatri c incidence was 2.5 per 100 000 population. Median age at presentation was 34 months. Common features at presentation were splenomegaly, hepatomegaly, fever, and pancytopenia with high lymphocyte and monocyte counts. The diag nostic sensitivity of isolated immunofluorescent antibody testing was equiv alent to bone marrow aspiration (95%). Blood transfusions for anaemia were required in 93% of patients. Eleven per cent had intercurrent infections. A ll patients were cured, and were initially treated with intravenous sodium stibogluconate. Defervescence occurred after a median of six days of treatm ent, and patients continued to be treated on a day case basis. Nine relapse rs were retreated with sodium stibogluconate, achieving a cure rate of 94%, but five patients required additional drug therapy. There were no permanen t sequelae associated with VL or its treatment. Conclusions-The decreased incidence is attributed to the eradication of str ay dogs which are the disease reservoir.