Some epidemiological aspects of visceral leishmaniasis (kala-azar) in children of Al dejail district.


Background:Visceral leishmaniasis(Kala-azar) is a parasitic disease of human ,belonging to the genus Leishmania, a protozoa transmitted by the bite of a tiny 2 -3 millimeter-long insect vector, the phlebotomies sand fly.Aldejail district of a high population density is one of highly endemic zone of the disease in IraqAim:To study some epidemiological aspects of visceral leishmaniasis in Aldejail district and monitoring the occurrence of cases of leishmaniasis through epidemiological surveillancePatient and methods:A 45 cases of Visceral eishmaniasis (VL) from Aldejail sector and territory had been studied regarding some epidemiological points of view including age ,sex ,seasonal distribution, residence (urban versus rural areas),socioeconomic status, presenting manifestation and its frequency ,severity of anemia at time of presentation and response to Sodium Stibogluconate (pentostam) as a traditional medication widely used in our country.The diagnosis was based on clinical presentation of (VL) in addition to confirmatory serological tests (rK39 & IFAT for Kalazar) and /or bone marrow examination.Results:from a total 45 cases of VL randomly enrolled in this study , 25 cases (55.5 %) were 0-2 years age with a decreasing percentages with advanced age , there was a slight male predominance 24 males( 53.4%) while 21were females (46.6%) .Disease was more in rural than urban areas with a percentages of 35 cases(77.8%) and 10 (22.2% ) respectively . They were presented in a sequence of fever in all patients (100% ) as a major presenting complaint , also hepatosplenomegaly in (100 % ) , anemia in 39 cases( 86.7%) , cough in 12 cases (26.6%) , jaundice was seen in 12 children (22% ) , odema and ascitis in 7 cases( 15.5%) , bleeding tendency in 2 cases ( 4.4% ) , while lymphadenopathy was not recoreded in any case of this study.All cases were treated with Sodium stibogluconate (pentostam) in a dose of 15 mg/ kg for 21 days intramuscularly once daily , showed clinical improvement except for 2 cases who died on 2nd day of hospital admission due to very advanced disease ,massive bleeding with septic shock .Sodium stibogluconate was highly effective in 43 cases (94.5% ).Haematological finding revealed anemia in 37 case (82.3%) while sever anemia ( Hb level >7 gm/ dl) recorded in 22 children (40.5%).Pancytopenia as a feture of the disease was seen in 32 cases (71.2%)Conclusion:Aldejail is highly endemic area for Kala-azar which was targeting mainly children in the first 2 years of life , mainly in winter and spring seasons .V.L must be suspected in any case with high prolonged fever especially if it was accompanied with hepatosplenomegaly.The disease was highly spread in rural areas where was the preferable inhibitant of sandflySodium stibogluconate(pentostam ) was the main effective treatment in our area.