Resumen

BELTRAN SILVA, Sandra Luz; MARTINEZ-DOMINGUEZ, Rosa; ENRIQUEZ-GALLEGOS, Moisés  y  SANTOS-PRECIADO, José Ignacio. Visceral leishmaniasis: 20 years of clinical experience in a pediatric population of a reference hospital in Chiapas, Mexico. Bol. Med. Hosp. Infant. Mex. [online]. 2011, vol.68, n.2, pp.91-96. ISSN 1665-1146.

Background. We undertook this study to describe the clinical experience in diagnosis and treatment of visceral leishmaniasis in patients <15 years of age who were treated from 1990-2010 in the Hospital General Dr. Rafael Pascacio Gamboa of Tuxtla Gutiérrez, Chiapas. Methods. This was a retrospective descriptive study. We reviewed the clinical files and epidemiological reports from the Department of Pediatrics of the Hospital General Dr. Rafael Pascacio Gamboa of Tuxtla Gutiérrez, Chiapas. All patients with a diagnosis of visceral leishmaniasis confirmed by serology, indirect immunofluorescence and the presence of amastigotes in the bone marrow aspirate were included. Epidemiological and clinical data were collected. Results. From 1990-2010, 72 children with the diagnosis of visceral leishmaniasis were reported. Nine cases were discarded because necessary data for the analysis were not collected. Sixty three subjects who were analyzed were between 2 months and 13 years of age; 56 (88%) were <5 years of age. Female:male ratio was 1:1.2. Fever was present in 100% of the cases, splenomegaly in 97%, hepatomegaly in 87% and pancytopenia in 95%. Serology for leishmania by indirect immunofluorescence was >1:32, positive in 98% of cases. The presence of amastigotes was found in 79% of the bone marrow aspirates. Leishmania chagasi was identified in culture medium 3N (Nicolle-Novy-McNeal) in five children; 75% of the children presented malnutrition. Conclusions. In the state of Chiapas, diagnosis of visceral leishmaniasis should be considered in patients with fever, hepatosplenomegaly, and pancytopenia. The search for the parasite should be begun early to avoid clinical deterioration and pain, which leads to malnutrition and puts patients at risk of dying.

Palabras llave : visceral leishmaniasis; Chiapas; hepatoespelnomegaly; pancytopenia.