Visceral leishmaniasis in a 10-month-old Austrian girl Epidemiological Aspects and Treatment Strategies with review of the Iiterature

Author(s): Hans Jürgen Dornbusch, Thomas Perwein, Petra Ritter-Sovinz, Christian Urban

Background: Visceral leishmaniasis is prevalent in India, western and eastern parts of Africa, Central America and Brasil, but also in the mediterranean area. In the latter region mainly infants and preschool children as well as immunocompromised patients are affected and Leishmania donovani infantum is the etiologic agent. So far there are only rare reports of probably indigenous cases in central Europe.

Case report: A 10-month-old girl from southern Austria was admitted because of protracted fevers, paleness and hepatosplenomegaly after insect stings acquired at home and during vacation at the Italian Riviera. Laboratory evaluation revealed pancytopenia with marked anemia as well as elevated inflammatory parameters, LDH, AST, protein and gammaglobulin. Bone marrow cytology and positive serology confirmed the diagnosis of visceral leishmaniasis. Treatment with liposomal Amphotericin B (5 mg/kg/day i.v. from day 1 to 5 and on day 10) was well tolerated and resulted in rapid clinical improvement with normalisation of lab values and clearance of the parasites from the bone marrow.

Conclusion: In case of fever, hepatosplenomegaly, pancytopenia and suggestive travel history visceral leishmaniasis should be considered. In this case the possibility of transmission in southern Austria cannot be excluded. Treatment with liposomal Amphotericin B is safe and highly effective.