American visceral leishmaniasis (kala-azar) in hospitalized children from an endemic area.

OBJECTIVE To study epidemiological and clinical aspects of American visceral leishmaniasis in hospitalized children in Ceará, Brazil. METHODS A retrospective and observational study was carried out with children suffering from American visceral leishmaniasis admitted to Hospital Infantil Albert Sabin in Fortaleza. Medical records were reviewed consistently. Inclusion criteria were children with amastigote-positive smears in bone marrow or in splenic aspirates, or a positive Leishmania sp immunofluorescence assay. RESULTS From January 1995 to December 2002, 450 children with American visceral leishmaniasis were identified, accounting for 9 to 27% of all reported cases in Ceará in that period, with peak hospitalization rates in 1995 and 2000. The mean age was 4.4 years (12% < 1 year and 65% < 5 years of age). The overall male: female ratio was 1.1 and 1.48 in children > 5 year (p = 0.04). Urban patients infected by American visceral leishmaniasis increased steadily over an 8-year period (chi2 p = 0.01). The main clinical complaints on admission were fever (96%), pallor (90%) and abdominal swelling (75%). Clinical cure was defined as the absence of fever, regression of splenic and hepatic enlargement and of pancytopenia. Overall mortality was 9.2% and 21.2% in patients younger than one year. Malnutrition, edema, bleeding, jaundice, and concomitant infections were related to higher mortality. CONCLUSIONS Cases of American visceral leishmaniasis spiked with a 5-year interval, and affected most under-five urban children. Mortality was related to low age, signs of severe disease and concomitant infection.