Epidemiological insights and clinical management of paediatric kala-azar in Shanxi Province (2014-2023): retrospective analysis of case characteristics and therapeutic strategies.

Abstract

Background: From 2019 to 2020, Shanxi Province reported the highest incidence of kala-azar (visceral leishmaniasis) in China. Despite this, research on the disease in paediatric populations, particularly in the Shanxi region, remains limited. No comprehensive data have been published on the occurrence and clinical characteristics of kala-azar in children within this region. This study seeks to address this gap by investigating the epidemiological features, clinical manifestations and therapeutic strategies for paediatric visceral leishmaniasis in Shanxi Province, providing critical insights for improving prevention and management efforts.

Methods: A retrospective analysis was conducted on medical records of 89 paediatric patients diagnosed with kala-azar at Shanxi Children's Hospital between January 2014 and December 2023. This study examined epidemiological data, clinical manifestations, therapeutic interventions and patient outcomes.

Results: (1) Among the 89 kala-azar cases, the male-to-female ratio was 1.34:1, indicating a higher prevalence among males. Infants aged (0-3 years) constituted the largest proportion of cases, accounting for 58.43% (52/89). The seasonal peak occurred during summer (May-July), with 46.07% (41/89) of cases identified during this period. Geographically, the cases were distributed across seven districts and cities in Shanxi Province, with the majority being reported in Yangquan city. (2) The most common clinical symptoms observed were irregular fever and hepatosplenomegaly. Laboratory findings revealed leucopenia in 73 cases, decreased platelets in 69, decreased haemoglobin in 79, elevated erythrocyte sedimentation rate in 16 and elevated C reactive protein in 78. Additionally, respiratory infections were noted in 31 cases, haemophagocytic syndrome in 24, gastrointestinal infections in 15 and sepsis in 7. (3) The treatment regimen using sodium stibogluconate achieved a cure rate of 96.63% (86/89).

Conclusions: To improve diagnostic accuracy and patient outcomes, clinicians are advised to thoroughly investigate the medical and travel history of paediatric patients. For suspected cases, enhanced diagnostic methods, including serum antibody testing and bone marrow aspiration smear examinations, should be employed to minimise misdiagnoses and missed cases. Sodium stibogluconate or amphotericin B is recommended for confirmed cases to optimise prognosis.