Visceral leishmaniasis: also beware of these deceptive microbes in non-endemic countries

Patient 1 Patient 2 Patient 3 Age at diagnosis (years) 1 1.5 2 Holiday destination where infected South of France Elba South of Spain Interval from exposure to appearance of symptoms (months) 7 12 6-18 Interval between appearance of symptoms and diagnosis (weeks) 6 3 12 Hepatomegaly (cm) 6 1 5 Splenomegaly (cm) 10 3 15 Hb (mmol/dl) 2.9 3.0 4.1 WBC (x 109/l) 4.5 3.5 1.5 Platelets (x 109/l) 47 107 10 Ferritin (μg/) 10813 260 4612 LDH (U/l) 4779 911 1761 Triglycerides (mmol/l) 3.64 6.9 3.9 Serum IgG (g/l) 13.9 15.6 36 LDH = lactase dehydrogenase Naturally, we cannot draw epidemiological conclusions from such a small number of patients, but it is intriguing to find three unrelated cases within a relatively short time. While the eradication of stray dogs may go a long way to reduce the incidence of VL, vaccination would be more desirable. 2 Although resistance and immunity against the leishmania parasites is not well understood, the seemingly increasing incidence of VL in children travelling from Northern Europe might be because they have no transplacental immunity against the parasite and are therefore more prone to develop this condition than local children.