关键词: 内脏利什曼病, 儿童, 流行病学调查, 温州

Abstract:

A child case of visceral leishmaniasis was diagnosed in Wenzhou, Zhejiang Province and the epidemiological investigation was performed on this case to identify the cause of infection, clinical manifestation, treatment and prognosis in order to provide a reference for better prevention and control of kala-azar. A patient with 8 years old originally from Qingtian County of Lishui Municipality was hospitalized with symptoms of fever and vomiting started on January 17, 2018. The physical examination found the swollen tonsil, but did not find enlargement of lymph node around the body. Lips were pale. The spleen could be touched 2 cm below the rib. Blood test showed decreased number of white blood cells, red blood cells and platelet, increased ferritin. The activity of natural killer(NK) cells was decreased. Bone marrow smear demonstrated phagocytosis of red blood cells by macrophages. Serological test showed epstein-barr (EB) virus antibody positive, so diagnosed as “EB virus infection-related hemophilic syndrome”. After being treated with VP16, CSA and ganciclovir, the patient got improved in symptoms and discharged from hospital on February 5. The patient was hospitalized on February 19 for the second chemotherapy with VP16 and CSA. The amastigotes of Leishmania donovani was identified in bone marrow hematopoietic smear on March 21. A 120 bp fragment of Leishmania kinetoplast DNA was amplified by PCR. The diagnosis of kala-azar was confirmed. After being treated with standard anti-Leishmania antimony gluconate (intravenous injection of pentavalent antimony 600 mg/day for 6 days, paused for 2 days, followed by pentavalent antimony 300 mg/day for additional 12 days), the symptoms of the patient were improved. It has been confirmed that it was a case of imported kala-azar, most likely infected by the bite of infected sandflies in the park near his home in Spain.

Key words: Visceral leishmaniasis, Child, Epidemiological investigation, Wenzhou