November 1991

Mediterranean Visceral Leishmaniasis: A Frequently Unrecognized Imported Disease

Author Affiliations

Department of Pediatrics University Hospital of Antwerp Wilrijkstraat 10 B-2650 Antwerpen, Belgium

Am J Dis Child. 1991;145(11):1225-1227. doi:10.1001/archpedi.1991.02160110015008

Sir.—Visceral leishmaniasis is endemic in countries surrounding the Mediterranean Sea. With mass tourism, nonresidents returning from this area are now also increasingly affected.1,2 However, it appears from the literature that this diagnosis is often not considered in these patients, that numerous unnecessary investigations are performed, and that appropriate treatment of this potentially fatal infection is delayed or withheld.3 This is clearly illustrated by the following report.

Patient Report.—A 10-month-old boy was referred to our department because of a persistent spiking fever of 3 weeks' duration that had not responded to oral treatment with amoxicillin and cefadroxil. Clinical investigation on admission revealed a fever of 40°C, marked hepatosplenomegaly, paleness, and slightly enlarged inguinal lymph nodes. Abnormal results of laboratory investigation were severe hypochromic anemia, leukopenia with neutropenia, thrombocytopenia, increased C-reactive protein levels, and positive results of a direct Coombs' test (Table). Roentgenograms of the chest and results

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