This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Meinecke, C. K.
Right arrow Articles by Fleischer, B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Meinecke, C. K.
Right arrow Articles by Fleischer, B.
Related Collections
Right arrow Infectious Disease & Immunity

PEDIATRICS Vol. 104 No. 5 November 1999, p. e65

ELECTRONIC ARTICLE:
Congenital Transmission of Visceral Leishmaniasis (Kala Azar) From an Asymptomatic Mother to Her Child

Received Oct 21, 1998; accepted May 17, 1999.

Christoph K. Meinecke*, Justus SchotteliusDagger , Linda Oskam§, and Bernhard FleischerDagger

From the * Children's Hospital of Stuttgart (Olgahospital), Stuttgart, Germany; Dagger  Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; and the § Department of Biomedical Research, Royal Tropical Institute, Amsterdam, the Netherlands.

In this article, we report the case of a 16-month-old German boy who was admitted to the Children's Hospital of Stuttgart with a 4-week history of intermittent fever, decreased appetite, weakness, fatigue, and difficulty sleeping. He was healthy at birth and remained so for the first 15 months of his life. On admission, physical examination showed enlarged cervical, axillary, and inguinal lymph nodes, as well as hepatosplenomegaly. Laboratory data revealed pancytopenia, elevated liver function tests, and hypergammaglobulinemia. Blood, stool, and urine culture results were negative. Viral infections and rheumatologic and autoimmune disorders were ruled out, but a positive titer for Leishmania antibodies was noted. In a liver and bone marrow biopsy, the amastigote form of the parasite could not be seen in cells. The promastigote form of Leishmania was found and the diagnosis of visceral leishmaniasis was made by combining the cultures of both the liver and the bone marrow biopsy material in 5 mL 0.9% saline on brain heart infusion agar, supplemented with defibrinated rabbit blood and incubated at 25 to 26°C for 5 days. The parasite was identified by Southern blot analysis as Leishmania infantum.

Specific therapy with the antimonial compound sodium stibogluconate with a dose of 20 mg/kg body weight was begun immediately. Within 4 days, the patient became afebrile. The side effects of treatment, including erosive gastritis, cholelithiasis, worsening hepatosplenomegaly, elevation of liver enzymes, pancreatitis, and electrocardiogram abnormalities, necessitated the discontinuation of treatment after 17 days. On discharge 4 weeks later, the patient was stabilized and afebrile with a normal spleen, normal complete blood count, normal gammaglobulins, and decreasing antibody titers to Leishmania. During the next 24 months, the patient experienced intermittent episodes of abdominal pain, decreased appetite, recurrent arthralgia, and myalgia. But at his last examination in January 1998, he was well; all symptoms mentioned above had disappeared.

Because the child had never left Germany, nonvector transmission was suspected and household contacts were examined. His mother was the only one who had a positive antibody titer against Leishmania donovani complex. She had traveled several times to endemic Mediterranean areas (Portugal, Malta, and Corse) before giving birth to the boy. But she had never been symptomatic for visceral leishmaniasis. Her bone marrow, spleen, and liver biopsy results were within normal limits. Culture results and polymerase chain reaction of this material were negative. A Montenegro skin test result was positive, indicating a previous infection with Leishmania. Western blot analysis showed specific recognition by maternal antibodies of antigens of Leishmania cultured from the boy's tissue.

Visceral leishmaniasis is endemic to several tropical and subtropical countries, but also to the Mediterranean region. It is transmitted by the sand fly (Phlebotomus, Lutzomyia). Occasional nonvector transmissions also have been reported through blood transfusions, sexual intercourse, organ transplants, excrements of dogs, and sporadically outside endemic areas. Only 8 cases of congenital acquired disease have been described before 1995, when our case occurred.

In our patient, additional evaluation showed that the asymptomatic mother must have had a subclinical infection with Leishmania that was reactivated by pregnancy, and then congenitally transmitted to the child. Visceral leishmaniasis has to be considered in children with fever, pancytopenia, and splenomegaly, even if the child has not been to an endemic area and even if there is no evidence of the disease in his environment, because leishmaniasis can be transmitted congenitally from an asymptomatic mother to her child.

 Key words:  visceral leishmaniasis in infants, kala azar, congenital transmission, nonvector transmission.




This article has been cited by other articles:


Home page
 J. Leukoc. Biol.Home page
Y. Osorio, D. L. Bonilla, A. G. Peniche, P. C. Melby, and B. L. Travi
Pregnancy enhances the innate immune response in experimental cutaneous leishmaniasis through hormone-modulated nitric oxide production
J. Leukoc. Biol., June 1, 2008; 83(6): 1413 - 1422.
[Abstract] [Full Text] [PDF]

Home page
 J Antimicrob ChemotherHome page
P. Pagliano, M. Rossi, C. Rescigno, S. Altieri, M. G. Coppola, M. Gramiccia, A. Scalone, L. Gradoni, and F. Faella
Mediterranean visceral leishmaniasis in HIV-negative adults: a retrospective analysis of 64 consecutive cases (1995-2001)
J. Antimicrob. Chemother., August 1, 2003; 52(2): 264 - 268.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
T RÉVÉSZ, T F W WOLFS, G KARDOS, A M VAN FURTH, and V GRECH
Visceral leishmaniasis: also beware of these deceptive microbes in non-endemic countries! Dr Grech comments:
Arch. Dis. Child., April 1, 2001; 84(4): 373b - 373.
[Full Text]