Visceral leishmaniasis in a six month old child: is congenital transmission of disease possible?

Infantile kalaazar is a sppradic disea.se and occurs in many countries of the Mediterranean region, Middle East and China. The causative organism of this disease is L. infanturn and is primarily a zoonosis, occurring in dogs and other wild carnivores which serve as reservoir. Transmission of leishmaniasis occurs by the bite of the female phiebotomine sandfiies and although numerous species are found in endemic areas, only a few have so far been proven as vectors. Pb.alexandri in China, Ph.rnartini in the Sudan and Ph.argentepes in India are the confirmed vectors of L. donovani infections. For L. infanturn infections, Ph.ariasi, Pb.perfeliewi and Pb.perniciosus have thus far been incriminated. First reports of visceral leishmaniasis from Pakistan came in the early sixties. Cases mostly children, were described from the valleys of Gilgit and Skurdu situated at a height between 7500 to 8500 feet above sea level. Later studies revealed that the disease was also present in Kashmir and its adjoining regions. The disease is sporadic and clinically resembles the Mediterranean type of visceral leishmaniasis. In at least one isolate obtained from bone marrow of a 2 year old male child from Murree hills the organism was typed as L.infantum s.s. by isoenzyme characterization. Different species of sandifies exist not only in this area, but are also found in the neighbouring areas of Kashmir valley. The disease affects mainly children although adults are not entirely immune. In north-west China 95% of cases were children below the age of 10 years and those reported in Pakistan have all been above one year,although the disease does occur occasionally in younger children. We describe a case of 6 month old boy from Bagh in Azad Jammu and Kashmir.