Clinico-Hematological Findings of Acute Pediatric Visceral Leishmaniasis Referred to the Northeast of Iran during 2005-2015

摘要

Background: To characterize the epidemiological, clinical, hematological and biochemical features of 33 cases hospitalized with pediatric visceral leishmaniasis (PVL) in North Khorasan Province of Iran from 2005 to 2015. Methods: The serological, hematological and biochemical tests were employed in 33 children between 8 months to 6 yr with a final diagnosis of acute visceral leishmaniasis (VL). The diagnosis of VL was established by microscopic demonstration of Leishmania spp. amastigotes inactive bone marrow aspiration (BMA). Results: The most common presenting features were anemia (82. 5%), fever (75%), and hepatosplenomegaly (45. 4%). Various hematological parameters showed that most patients were suffering from moderate to severe microcytic hypochromic anemia (78. 8% had RBC count less than 4 million cells/ul, 67. 7% Hb less than 8 fl). 66. 7% of them were leukopenic (WBC: less than 5× 103 /μ L) and 24. 2% had decreased platelet counts. Pancytopenia was observed in 18. 2% of cases. MCV, MCH, and MCHC levels were below the reference range in 88%, 90% and 85. 1% of the patients respectively. Moreover, aspartate transaminase (AST) and alanine transaminase (ALT) levels were increased in 53. 33% and 6. 66% of the patients respectively. 92. 9% of cases were C-reactive protein (CRP) positive. Bone marrow was found hyper-cellular in all of them, and myeloid to erythroid ratio (M/E) was more than 4 in 39. 1% of cases. Plasma cells slightly were increased in 60% of patients and megakaryocytes were decreased in thrombocytopenic patients. Conclusion: Bone marrow/splenic aspiration still remains the gold standard test despite its risk and pain for patients.