CLINICAL PRESENTATION AND MANAGEMENT OF VISCERAL LEISHMANIASIS
AbstractBackground: Febrile illnesses like malaria, typhoid, and tuberculosis are the commonestproblems in our area, but visceral leishmaniasis (VL) is also one of the diseases presenting withfever in this part of the country. This study was conducted to evaluate its clinical spectrum andway of management. Methods: This study was conducted in Paediatric Department of Womenand Children Hospital and Ayub Teaching Hospital, Abbottabad from October 1985 to August1999 during which 70 cases of VL were diagnosed and managed. Results: All patients werebelow 10 years of age and were from Hazara division. Majority of them were from two specificlocalities, one in Abbottabad District (43%) and the other in Mansehra District (14%). Commonclinical features were Fever 99%, Splenomegaly (99%), Anaemia (96%), Hepatomegaly (86%),distension of abdomen (47%) and bleeding diathesis 14%. Haemoglobin was below 7.9 gm in82.86%, white cell count was below 4000/mm3 in 42.85%, Platelet count was below 100000/mm3in 67.14% and ESR was >50 mm at the end of first hour in 86% of the patients. All the patientsshowed Leishmania Donovani bodies in the bone marrow smears except one, where tap was dryand then trephine biopsy was performed to confirm the diagnosis. In 67 cases amastigote formwas found and only in 3 patients the promastigotes were found. Fifty two patients had receivedmeglumine antimoniate (glucantime) and 18 received sodium stibogluconate (pentostam) alongwith supportive therapy. Mortality was 11.43%. Conclusions: The disease is gradually spreadingsouthwards in the country. Children below 5 years are mainly affected. Bone marrowexamination is the most reliable and simple method of diagnosis. A high index of suspicion musthe kept in mind for all febrile cases coming from Hazara division, Northern areas, Azad Kashmir.Keywords: Leishmaniasis, Visceral Leishmaniasis, Febrile Illness
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