Visceral leishmaniasis in children in South France.

Fifty-nine cases of children with visceral leishmaniasis were retrospective ly studied in a survey of hospital records in the Provence region of South France concerning a 15 years period (1981 to 1997). None of the children wa s immunocompromised. The mean age was 31 months but 10 children were younge r than one year. The male/female ratio was 0.73. Fever and splenomegaly wer e present in 90% and 100% of the cases respectively Anemia, leukopenia and thrombocytopenia were commonly observed. A medullogram was systematically p erformed but direct microscopic examination of the bone marrow identified L eishmania in only 78% of the cases. In these patients, specific serology an d genomic amplification using polymerase chain reaction were useful tools f or the diagnosis. All patients were initially treated with meglumine antimo nate (Glucantime(R)). Twenty-six (44%) receiving the drug experienced at le ast one adverse event during treatment Treatment failure occurred in 6 chil dren (10%), who were subsequently cured with liposomal amphotericin B. Thre e additional children were treated with liposomal amphotericin B. All the c hildren were finally cured and no death was observed Pediatric visceral lei shmaniasis is an uncommon disease in the endemic area of South France. Resi stance to antimonial therapy occurs in children as well as in adults Liposo mal amphotericin B appears as an effective therapy for visceral leishmanias is in children and could be used as a first-line treatment (C) 2000 Edition s scientifiques et medicales Elsevier SAS.