Sixty-seven cases of visceral leishmaniasis managed at the Rabat Hospital for Children from 1979 through 1988 were studied retrospectively. Mode of onset and outcome were analyzed. Clinical manifestations included enlargement of the spleen (60 cases), fever (45 cases), enlargement of the liver (38 cases), and weight loss (53 cases). Six patients had misleading onset manifestations including one case each of pigmentary lithiasis, severe marasmus without enlargement of the spleen, nephrotic syndrome, evidence of portal hypertension, jaundice, and an abdominal mass. Diagnosis was established by the bone marrow study (positive in 58 of 66 patients) or by indirect immunofluorescence (positive in 21 of 24 patients, including 6 with a negative bone marrow study). In one patient, the parasite was recovered from a jejunal biopsy specimen. Drugs used included N-methyl-glucamine in 86 cases, pentamidine in 26 cases, and sodium gluconate stibio in one case. Complete recovery was achieved in 24 patients. Seven patients failed to respond to therapy. There were 8 deaths, including 4 prior to initiation of therapy; among these four deaths, three were due to acute anemia. Another patient died after leaving the hospital despite the physician's advice to the contrary. The 3 remaining deaths were caused by toxicity of the drugs used. Thirty-one patients were lost to follow-up after initial improvement. The severity of this disease and cost of management make earlier diagnosis and faultless management imperative.
