Epidemiological, Clinical, and Biological Characteristics of Infantile Visceral Leishmaniasis: A Study of 69 Cases

Visceral infantile leishmaniasis is a parasitic infection caused by the multiplication in the reticuloendothelial system of a flagellate protozoan of the Leishmania genus, specifically the infantum species in the Moroccan context. It is transmitted through the bite of an insect known as a sandfly (phlebotomine). This study aimed to outline the epidemiological, clinical, and biological profiles of this pathology in a pediatric setting and to examine the different therapeutic modalities in order to improve its prognosis. A retrospective study spread over a period of seven years (from January 1, 2017, to December 31, 2023) was carried out in the Parasitology Laboratory of the Avicenna Military Hospital and the Pediatric Department of Mohammed VI University Hospital Center. For the 69 patients included in this study, we collected geographical origin, age, sex, clinical data, and biological data. The average age was two years and 11 months with a slight masculine predominance. The clinical triad - fever, pallor, and splenomegaly - was found in 53 (78%) patients. Normochromic normocytic anemia was almost constant (n=67, 97%) followed by thrombopenia (n=60, 87%) and leukopenia (n=40, 57%). The diagnosis has been confirmed by the search for the parasite in the bone marrow in 61 (89%) cases. The indirect diagnosis was made using screening techniques, such as ELISA, IFI, and rapid diagnostic tests, associated with the western blot confirmation technique. These techniques made it possible to recover the diagnosis in the remaining eight (11%) cases. N-methylglucamine was used as a first-intention treatment. A favorable evolution was observed in the majority of patients; however, we deplored three deaths and two relapses which pose a real management challenge, requiring collaboration between the clinician and the parasitologist for better case analysis.