Cases of visceral leishmaniasis in children: a difficult path to diagnosis
G. V. Gopatsa,
V. V. Khoreva,
N. Y. Pshenichnaya,
T. A. Chebotareva,
L. A. Ermakova,
N. A. Antypyat,
N. N. Zvereva,
R. F. Sayfullin https://doi.org/10.22627/2072-8107-2026-25-1-60-65
Abstract
This article presents two clinical cases of visceral leishmaniasis (VL) in children under 5 years of age, one of which was complicated by hemophagocytic syndrome (HPS). Both cases illustrate the diagnostic challenges encountered in non-endemic regions, where VL may mimic malignancies, hematologic, or infectious diseases. The authors describe the diagnostic algorithm involving bone marrow microscopy, molecular (PCR) testing, and differential diagnosis. The treatment strategies included amphotericin B therapy and immunomodulatory treatment (dexamethasone and intravenous immunoglobulin) for VL with HPS complications. The article emphasizes the need to raise clinical awareness in non-endemic areas and to expand access to sensitive diagnostic methods to ensure timely identification of VL and prevent severe outcomes.
About the Authors
G. V. Gopatsa
Infectious Clinical Hospital №1; Central Scientific Research Institute of Epidemiology; Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Moscow
V. V. Khoreva
Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Moscow
N. Y. Pshenichnaya
Central Scientific Research Institute of Epidemiology; Russian Medical Academy of Continuing Professional Education; Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky,
Russian Federation
Russian Federation
Moscow
T. A. Chebotareva
Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Moscow
L. A. Ermakova
Russian Medical Academy of Continuing Professional Education; Rostov Scientific Research Institute of Microbiology and Parasitology
Russian Federation
Russian Federation
Moscow
Rostov-on-Don
N. A. Antypyat
Infectious Clinical Hospital №1
Russian Federation
Russian Federation
Moscow
N. N. Zvereva
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Moscow
R. F. Sayfullin
Pirogov Russian National Research Medical University; Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Russian Federation
Russian Federation
Moscow
References
1. Borisov LB. Meditsinskaya mikrobiologiya, virusologiya i immunologiya: uchebnik [Medical microbiology, virology and immunology: textbook]. Moscow: Meditsinskoe informatsionnoe agentstvo; 2001. p. 736—737. (In Russ.)
2. Akhoundi M, Kuhls K, Cannet A, Votýpka J, Marty P, Delaunay P, et al. A Historical Overview of the Classification, Evolution, and Dispersion of Leishmania Parasites and Sandflies. PLoS Negl Trop Dis. 2016;10(3):e0004349. doi:10.1371/journal.pntd.0004349
3. Control of the leishmaniasis: report of a meeting of the WHO Expert Committee on the Control of Leishmaniases, Geneva, 22—26 March 2010. Geneva: World Health Organization; 2010.
4. Bekhtereva MK, Kozlov SS, Komarova AM, Lobzin YuV, Razdyakonova IV. Vistseral'nyy leyshmanioz u rebenka: slozhnosti diagnostiki i lecheniya [Visceral leishmaniasis in a child: difficulties in diagnosis and treatment]. Zhurnal Infektologii. 2019;11(3):118—125. (In Russ.) doi:10.22625/2072-6732-2019-11-3-118-125
5. World Health Organization. Leishmaniasis [Internet]. News room: fact sheets. Available from: https://www.who.int/news-room/fact-sheets/detail/leishmaniasis
6. Forestier CL. Imaging host-Leishmania interactions: significance in visceral leishmaniasis. Parasite Immunol. 2013; 35(9—10):256—266. doi:10.1111/pim.12043
7. Zijlstra EE. Precision Medicine in Control of Visceral Leishmaniasis Caused by L. donovani. Front Cell Infect Microbiol. 2021; 11:707619. doi:10.3389/fcimb.2021.707619
8. Gálvez R, Montoya A, Cruz I, et al. Latest trends in Leishmania infantum infection in dogs in Spain, Part I: mapped seroprevalence and sand fly distributions. Parasit Vectors. 2020;13:204. doi:10.1186/s13071-020-04081-7
9. Costa CHN, Chang KP, Costa DL, Cunha FVM. From Infection to Death: An Overview of the Pathogenesis of Visceral Leishmaniasis. Pathogens. 2023;12(7):969. doi:10.3390/pathogens12070969
10. Lodi L, Voarino M, Stocco S, Ricci S, Azzari C, Galli L, Chiappini E. Immune response to viscerotropic Leishmania: a comprehensive review. Front Immunol. 2024;15:1402539. doi:10.3389/fimmu.2024.1402539
11. Akuffo H, Costa C, van Griensven J, Burza S, Moreno J, Herrero M. New insights into leishmaniasis in the immunosuppressed. PLoS Negl Trop Dis. 2018;12(5):e0006375. doi:10.1371/journal.pntd.0006375
12. Soares AGR, Landim JdS, França NG, et al. Differential diagnosis of visceral leishmaniasis in children: a five-year retrospective study at a pediatric referral hospital. BMC Pediatr. 2024;24:726. doi:10.1186/s12887-024-05160-9
13. Brovko MYu, Akulkina LA, Potapov PP, et al. Vistseral'nyy leyshmanioz: trudnyy differentsial'nyy diagnoz v terapevticheskoy praktike [Visceral leishmaniasis: a difficult differential diagnosis in therapeutic practice]. Terapevticheskii Arkhiv. 2020;92(11):117—121. (In Russ.) doi:10.26442/00403660.2020.11.000619
14. Dondi A, et al. A 10-year retrospective study on pediatric visceral leishmaniasis in a European endemic area: diagnostic and short-course therapeutic strategies. Healthcare. 2023;12(1):23. doi:10.3390/healthcare12010023
15. Baranets MS, Ermak TN, Ponirovsky EN. Kliniko-epidemiologicheskie osobennosti vistseral'nogo leyshmanioza v Respublike Krym [Clinical and epidemiological features of visceral leishmaniasis in the Republic of Crimea]. Terapevticheskii Arkhiv. 2017;89(11):100—104. (In Russ.)
16. Ermakova LA, Golovchenko NV, Nagorny SA, Pshenichnaya NYu, Avanesova LA, Zhuravlev AS. Autokhtonnyy sluchay kozhnogo leyshmanioza u bol'nogo s VICh-infektsiey [Autochthonous case of cutaneous leishmaniasis in a patient with HIV infection]. VICh-infektsiya i Immunosupressii. 2019;11(1):75—80. (In Russ.)
17. Bayo SM, González EL, Bellés AB, Sánchez AB, Arnuelos JA, de Tudela IJ, et al. Detection and pathological role of intestinal protozoa in children. Parasitol Int. 2022;88:102558. doi:10.1016/j.parint.2022.102558
18. Lebedeva TM, Chuelov SB, Sayfullin MA, Rossina AL, Zvereva NN, Pylaeva EYu, et al. Autokhtonnyy vistseral'nyy leyshmanioz v Rossiyskoy Federatsii i rol' polimeraznoy tsepnoy reaktsii kak al'ternativnogo metoda diagnostiki [Autochthonous visceral leishmaniasis in the Russian Federation and the role of polymerase chain reaction as an alternative diagnostic method]. Detskie Infektsii=Children Infections. 2022;21(4):43—48. (In Russ.) doi:10.22627/2072-8107-2022-21-4-43-48
19. Alabaz D, Eroğlu F, Elçi H, Çay Ü. Identification of Leishmania tropica from Pediatric Visceral Leishmaniasis in Southern Mediterranean Region of Turkey. Mediterr J Hematol Infect Dis. 2022;14(1):e2022053. doi:10.4084/MJHID.2022.053
20. Scarpini S, Dondi A, Totaro C, Biagi C, Melchionda F, Zama D, et al. Visceral Leishmaniasis: Epidemiology, Diagnosis, and Treatment Regimens in Different Geographical Areas with a Focus on Pediatrics. Microorganisms. 2022;10(10):1887. doi:10.3390/microorganisms10101887
21. Maschan MA, Poltavets NV. Gemofagotsitarnyy sindrom v neotlozhnoy i intensivnoy pediatrii [Hemophagocytic syndrome in emergency and intensive pediatrics]. Pediatricheskaya Farmakologiya. 2011;8(2). (In Russ.)
22. Carvalho FH, Lula JF, Teles LD, Caldeira AP, Carvalho SF. Hemophagocytic lymphohistiocytosis secondary to visceral leishmaniasis in an endemic area in the north of Minas Gerais, Brazil. Rev Soc Bras Med Trop. 2020;53:e20190491. doi:10.1590/0037-8682-0491-2019
23. Scalzone M, Ruggiero A, Mastrangelo S, Trombatore G, Ridola V, Maurizi P, et al. Hemophagocytic lymphohistiocytosis and visceral leishmaniasis in children: case report and systematic review of literature. J Infect Dev Ctries. 2016;10(1):103—108. doi:10.3855/jidc.7190
24. Chakhunashvili DG, Chakhunashvili K, Kvirkvelia E. Visceral leishmaniasis misdiagnosed as an upper respiratory infection and iron-deficiency anemia in a 20-month-old male patient: a case report. J Med Case Rep. 2024;18(1):37. doi:10.1186/s13256-024-04356-y
25. Bode SF, Bogdan C, Beutel K, Behnisch W, Greiner J, Henning S, et al. Hemophagocytic lymphohistiocytosis in imported pediatric visceral leishmaniasis in a nonendemic area. J Pediatr. 2014;165(1):147—153. doi:10.1016/j.jpeds.2014.03.047
Review
For citations:
Gopatsa G.V., Khoreva V.V., Pshenichnaya N.Y., Chebotareva T.A., Ermakova L.A., Antypyat N.A., Zvereva N.N., Sayfullin R.F. Cases of visceral leishmaniasis in children: a difficult path to diagnosis. CHILDREN INFECTIONS. 2026;25(1):60-65. (In Russ.) https://doi.org/10.22627/2072-8107-2026-25-1-60-65
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