AJAVOLASIT, P

COLOMBA, Claudia

GIORDANO, S

INFURNARI, Laura

SAPORITO, Laura

TITONE LANZA DI SCALEA, Lucina

Archivio istituzionale della ricerca - Università di Palermo

Eur J Pediatr (2006) 165: 140DOI 10.1007/s00431-005-0026-7SHORT REPORTClaudia Colomba . Laura Saporito .Salvatore Giordano . Laura Infurnari .Patrizia Ajovalasit . Lucina TitoneVisceral leishmaniasis in a patient with Down syndromeReceived: 20 June 2005 / Accepted: 20 September 2005 / Published online: 22 November 2005# Springer-Verlag 2005Visceral leishmaniasis (VL) due to Leishmania infantum is avector-borne zoonotic disease endemic in Sicily. We reporton a case of VL that occurred in a child with a cardiopathiccondition and Down syndrome.In January 2005 a 6-month-old child with Down syn-drome underwent a surgical intervention for congenitalcardiopathy. Two months later the child returned to thepaediatric cardiosurgery department with a 5-day history offever. At admission, the patient was febrile, pale, with rarepetechial lesions. A greatly enlarged and hard spleen wasobserved. Laboratory examination revealed pancytopeniaand high gammaglobulin value. An immuno-fluorescenceantibody test (IFAT) for Leishmania spp. detected thepresence of anti-Leishmania antibodies. Bone marrow mi-croscopy and polymerase chain reaction (PCR) revealedthe presence of Leishmania parasites. Treatment withintravenous liposomal amphotericin B at a dose of 3 mg/kgper day was administered for 10 consecutive days. Defer-vescence was obtained after 3 days of treatment.At the end of therapy splenomegaly and hepatomegalywere reduced, haematological values were improved andanti-Leishmania antibodies (by IFAT) were undetectable.To our knowledge this is the first reported case of VL ina patient with chromosome 21 trisomy. Down syndrome isassociated with different immune dysfunctions, which havebeen correlated to a general predisposition to infection [2,4, 6]. Moreover, our patient was convalescent from majorsurgery, and this might have lead to further immuno-de-ficiency. In spite of these aggravating factors the patientshowed a typical clinical presentation and recovered in away that any child with immuno-competence would nor-mally recover. Undoubtedly, early diagnosis had an impor-tant role in the good outcome of the disease in our patient.The proven efficacy of liposomal amphotericin B in immuno-deficient subjects [3, 5] and the lack of cardiac side effects,already reported in a patient with Down syndrome treatedwith meglumine antimoniate [1], are the most importantadvantages of this therapy, especially in a patient with acardiopathic condition. In conclusion, we stress the need forthe paediatrician to consider VL in Down syndromechildren living in endemic areas so as to avoid misdiagnosis(immunological or neoplastic diseases) and, consequently,the wrong treatment, such as steroid therapy, which wouldmake worse the clinical course of leishmanial infection.References1. Ferreli C, Atzori L, Zucca M, Pistis P, Aste N (2004)Leishmaniasis of the lip in a patient with Down’s syndrome.J Eur Acad Dermatol Venereol 18:599–6022. Loh RK, Harth SC, Thong YH, Ferrante A (1990)Immunoglobulin G subclass deficiency and predisposition toinfection in Down’s syndrome. Pediatr Infect Dis J 9:547–5513. Montana M, Chochoi N, Monges P, Ravaux I, Faraut F,Gensollen S, Bongrand MC, Timon-David P, Gallais H (2004)Liposomal amphotericin B in secondary prophylaxis of visceralleishmaniasis in HIV-infected patients: report of five clinicalcases. Pathol Biol (Paris) 52:66–754. Tanaka S, Teraguchi M, Hasui M, Taniuchi S, Ikemoto Y,Kobayashi Y (2004) Idiopathic CD4+ T-lymphocytopenia in aboy with Down syndrome. Report of a patient and a review ofthe literature. Eur J Pediatr 163:122–1235. Torre-Cisneros J, Villanueva JL, Kindelan JM, Jurado R,Sanchez-Guijo P (1993) Successful treatment of antimony-resistant visceral leishmaniasis with liposomal amphotericin Bin patients infected with human immunodeficiency virus. ClinInfect Dis 17:625–6276. Ugazio AG (1981) Down’s syndrome: problems of immuno-deficiency. Hum Genet Suppl 2:33–39C. Colomba (*) . L. Saporito . S. Giordano . L. Infurnari .L. TitoneIstituto di Patologia Infettiva e Virologia,Università di Palermo,Piazza Porta Montalto,8-90134 Palermo, Italye-mail: claudia.colomba@libero.itTel.: +39-091-6666071Fax: +39-091-6514634P. AjovalasitU.O. Cardiochirurgia Pediatrica, ARNAS Civico,Palermo, Italy

Visceral leishmaniasis in a patient with Down syndrome

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Visceral leishmaniasis in a patient with Down syndrome

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