OUTCOME OF HOSPITALIZED CHILDREN WITH VISCERAL LEISHMANIASIS IN BASRAH, SOUTHERN IRAQ

Abstract

ABSTRACT Objectives: A prospective study was carried out to study the outcome of patients with visceral leishmaniasis and to determine factors associated with poor outcome. Methods: The study included 132 in-patient children who were admitted to Basrah Maternity and Children Hospital and Basrah General Hospital during one year(from the first of November 2004 till the end of October 2005), with visceral leishmaniasis confirmed by bone marrow examination and direct agglutination test. Nutritional assessment was done for each patient. All patients with confirmed visceral leishmaniasis were sent for complete blood count. The final diagnosis and the outcome of the patients with visceral leishmaniasis were recorded also. Results: Among 132 sero-positive cases, 78 (59.0%) cases were males, and 54(40.9%) were females. The age of patients ranged between 2 months to 12 years. Sixty five (49.2%) of the cases were improved, 31.8% were discharged on the family responsibility, and 15 cases died. The commonest cause of death was bleeding in 6 cases (40%), followed by hepatic failure in 4 (26.6%), other causes of death were bronchopneumonia, renal and heart failure. Nutritional status and duration of illness were significant determinants of the outcome of visceral leishmaniasis patients. A significantly higher number of malnourished patients didn’t improve compared to well nourished patients, and a significantly higher percent of patients who presented late have died compared to those who presented earlier especially in the first 2 weeks of illness, P<0.05. By using multivariate regression analysis, six variables; low hemoglobin value, low platelet count, male sex, young age, high Direct Agglutination Test titer and malnutrition were found to be significant predictors of death and relapse. Conclusion: Male sex, anemia, thrombocytopenia, high DAT titer and malnutrition are poor prognostic factors in addition late presentation.