CLINICOPATHOLOGICAL FEATURES OF CHILDHOOD VISCERAL LEISHMANIASIS IN AZAD JAMMU & KASHMIR PAKISTAN
AbstractBackground: In Pakistan visceral leishmaniasis (VL) is endemic in Azad Jammu & Kashmir,Northern Areas and Northwest Frontier Province; the areas which lack adequate diagnosticfacilities. This study describes the clinical and laboratory features in 61 cases of childhood VL.Methods: All the children below 12 years of age who were managed as indoor cases from 1st Jan1999 to 31st Dec 1999 were included in this study. The diagnosis of VL was established bydemonstration of leishmania parasites in bone marrow aspiration. The demographic information,physical signs at presentations and results of complete blood picture and formol gel test wererecorded. Results: Median age of the patients was 18 months. Eighty four percent children weremalnourished. Mean duration of fever before diagnosis was 45 days. Hepatosplenomegaly waspresent in all cases with mean enlargement of spleen and liver 6.8 and 3.2 cm respectively. Meanhaemoglobin level, WBC and platelet counts were 6.7 g/dl, 4.8 x 109 /l and 70 x 109 /lrespectively. Absolute neutrophil count was <1.5 x 109 /l in 61% cases. Mean reticulocyte countwas 6.2%. There was significant negative correlation (p= 0.014) between haemoglobin level andspleen size. Formol gel test was positive in all cases. Mean hospital stay to established diagnosiswas 8.6 days. Conclusion: The clinical and laboratory features of childhood VL in Azad Jammuand Kashmir are similar to Mediterranean type of disease caused by leishmania infantum.Cytopenia with high or normal reticulocyte count provides a useful clue to diagnosis in a febrilepatient with hepatosplenomegally in an endemic area.Key words: leishmaniasis, visceral childhood, clinicopathological
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