What is Visceral Leishmaniasis in Children?
Leishmaniasis is a protozoal disease in humans and animals, which can be either acute or chronic, caused by parasites from the class of flagella — Leishmania transmitted by mosquitoes.
Types of Leishmaniasis:
- visceral
- cutaneous.
Visceral leishmaniasis is a long-running disease, which is manifested by wave-like fever, anemia, hepatosplenomegaly, progressive cachexia.
Types of visceral leishmaniasis:
- Mediterranean visceral leishmaniasis
- kalaazar
- East African Leishmaniasis, etc.
The named types of leishmaniasis in children are similar in symptoms.
Causes of Visceral Leishmaniasis in Children
The causative agent of visceral leishmaniasis belongs to the simplest class of flagella. In the body of a child and an adult, it is located inside the cells, in the form of motionless oval or round shapes that are 2-6×2-3 microns in size.
In the body of the mosquito carrier, lanceolate mobile forms develop that have a size of 10-20×5-6 microns and long flagella.
The temperature most conducive to the growth of Leishmania is 22 ° C. They grow well on blood environments. Reproduction occurs by longitudinal division. To distinguish between types of parasite, RA is used. The characteristics of the disease are studied in laboratory animals such as mice, dogs, ground squirrels, rats, etc. They develop a generalized process when the pathogen is introduced into the body.
Epidemiology. The foci of the disease are in tropical countries, Central Asia, in the Caucasus and Kazakhstan. Sources of infection: jackals, dogs, foxes, rodents and other animals, as well as sick people. Infection is transmitted from a source to a healthy person by mosquitoes through bites.
People have a high susceptibility to both types of disease, mentioned above. In endemic foci, the majority of the population is ill at preschool age and acquires stable immunity. Repeated diseases are rare.
Pathogenesis during Visceral Leishmaniasis in Children
An itchy papule appears at the site of the bite after 2-4 days or more (up to several weeks). Sometimes it is covered with a crust or scales. This process is called primary affect. The pathogen spreads through the blood through the child’s body, settling in the cells (macrophages, Kupffer, etc.). There Leishmania multiply, which leads to systemic reticuloendotheliosis.
In the pathogenesis of leishmaniasis, specific intoxication is important, which is caused by metabolic products and the breakdown of the pathogen.
Pathomorphology. Morphological changes occur in the liver, spleen and bone marrow of the child. Atrophy of hepatic beams, degenerative changes and necrobiosis in hepatocytes are observed in the liver against the background of hyperplasia of lymphoreticular tissue; in the spleen – hemorrhagic infiltrates with atrophy of the capsule and malpighian bodies; in the bone marrow – reticular and erythroblastic hyperplasia; in the lymph nodes – reticular hyperplasia and plethora.
Symptoms of Visceral Leishmaniasis in Children
When infected with visceral leishmaniasis, incubation lasts from 20 days to 12 months. The average period is 3-6 months. The disease proceeds in cycles, is divided into the initial, anemic, terminal period. The anemic period is the height of the disease. The terminal period is also known as the cachectic.
The onset of the disease is gradual. The following symptoms are noted:
- subfebrile body temperature,
- weakness,
- decreased appetite,
- enlarged spleen (not always).
Symptoms gradually become brighter, the temperature rises. The temperature curve has a wave-like appearance (decreases and rises).
In the anemic period are observed:
- high short-term rises in body temperature up to 39–40°С,
- severe headaches,
- sweats,
- chills,
- enlarged liver and spleen,
- painlessness and density of these organs during palpation,
- swollen lymph nodes.
Gradually, the condition of the sick child worsens, manifestations of anemia occur. The skin acquires a waxy pallor, in some cases an earthy hue. The child has no appetite, dystrophy progresses. If treatment is not carried out, the disease passes into the final stage, characterized by sharp exhaustion and edema. There is a possibility of nosebleeds, hemorrhages in the skin, mucous membranes, gastrointestinal bleeding is also possible. Deafness of heart sounds, tachycardia, lowering of blood pressure are noted.
A blood test shows a reduced level of red blood cells, hemoglobin. Poikilocytosis (changes in the shape of red blood cells), anisochromia, anisocytosis, relative liadphocytosis, leukopenia, monocytosis, aneosinophilia, thrombocytopenia, and an increase in ESR are observed. The content of coagulation factors is reduced.
Visceral leishmaniasis in children happens:
- light
- moderate
- heavy.
The course of the disease is acute or chronic, as already noted in the definition of the term. An acute course is characteristic of infants and preschoolers. The disease begins with the fact that the child’s temperature rises to the level of 39-40 ° C and severe intoxication symptoms appear. General dystrophy and anemia progress rapidly. If adequate treatment is not done on time, then a fatal outcome occurs 3-6 months after the onset of leishmaniasis. Body temperature is increased for a long time, periodically rises even higher. Remission of fever may occur over several weeks or even months.
Without treatment, the symptoms of the disease in children progress. The liver and spleen become huge, anemia and general dystrophy, as well as cachexia, increase. Schoolchildren and adolescents have erased forms of visceral leishmaniasis, when the fever does not occur, the liver and spleen are slightly enlarged, and there are no changes in the blood.
Complications occur in severe forms of the disease. Usually they are caused by the attachment of a secondary bacterial flora (agranulocytic tonsillitis, pneumonia, enteritis, etc.). Spleen ruptures are rarely possible.
Diagnosis of Visceral Leishmaniasis in Children
The diagnosis of visceral leishmaniasis in children is based on characteristic symptoms, given the epidemic data. The causative agent of the disease is also found in punctured bone marrow or lymph node. Serological diagnostics is carried out by the methods of XRD, RSK, RIF, biological tests on laboratory white mice.
Treatment of Visceral Leishmaniasis in Children
The maximum therapeutic effect is given by antimony preparations: solusyurmin, glucanthim, etc. They are used in doses corresponding to the age of the sick child, I give injections to the muscle or intravenously. The course of treatment consists of 10-20 injections.
If the bacterial flora has joined the disease, antibiotics are prescribed. General strengthening therapy is also needed: blood transfusion, vitamin injections. The patient must adhere to a high-calorie diet.
Prevention of Visceral Leishmaniasis in Children
Prevention of visceral leishmaniasis requires the use of combined strategies. Measures relate to humans, parasites, carriers (mosquitoes) and animals (reservoir of infection). The strategy includes such measures:
- Early diagnosis and effective case management help reduce the spread of the disease. Today, there are effective drugs that effectively suppress the disease.
- You should fight with vectors: spray insecticides, use nets treated with an insecticide, rational use of personal protection.
- Disease surveillance is carried out. Earlier identification and treatment of children and adults with leishmaniasis is important. Monitoring the spread of the disease should be promoted.
- Animal control should be localized.
- They mobilize and educate local communities during effective measures aimed at changing behavior and communication strategies adapted to local conditions.