Diagnostic Dilemma - Pediatric Oncall
Kalaazar in child who has not visited endemic area
Author: Pediatric Oncall
An 11 month old girl resident of Mumbai born of non consanguineous marriage presented with cough and fever since 15-20 days. She had diarrhea with septic shock, meningitis and anemia 2 months back for which she was hospitalized and treated with intravenous antibiotics and blood transfusion. She was alright for 1 month and again had pneumonia with anemia and was again treated with intravenous antibiotics and blood transfusion. However, now fever has restarted since 20 days. Birth history, immunization, development is uneventful. On examination, she had pallor, hepatosplenomegaly with generalized lymphadenopathy.

Investigations over a period of 2 months are as follows:

• CSF = 16 cells, cumm {all lymphocytes}, 59 sugar with proteins of 105 mg, dl
• Renal functions and liver functions = Normal
• HIV, Leptospira, Dengue ELISA = Negative
• Hemoglobin electrophoresis = Normal
• S. cholesterol = 110 mg, dl
• Blood culture = Staphylococcus aureus
• Bone Marrow aspiration {Day 48} prior to 2nd blood transfusion = LD bodies
• Prothrombin time and Partial thromboplastin time = Prolonged
• Fibrinogen = 250 mg percent {increased}
• Ferritin = 1293 IU, L {Normal = 7-140 IU, L}
• Chest X-Ray = Right lower zone pneumonia

This child had never been to an area endemic for Kalaazar though mother had been there 6 months prior to getting pregnant. Child was treated with Inj Amphotericin B to which the fever, pancytopenia responded and hepatosplenomegaly regressed.

Answers of this discussion
Author :- Kishan Kumar Jani on 06 March 2013.
Answer :- Transplacental transfer followed by a period of dormancy of approximate 9-10 Months.

Author :- saravanan pal on 06 March 2013.
Answer :- transvertical transmission

Author :- clara pereira on 07 March 2013.
Answer :- Their pet dog was infected

Author :- anagha suresh on 07 March 2013.
Answer :- visceral leishmaniasis can be spread congenitally from asymptomatic mother to baby

Author :- Niyaz Ahmad Buch on 08 March 2013.
Answer :- by blood transfusion

Author :- Sarita Nanadakumar on 08 March 2013.
Answer :- blood transfusion

Author :- rachana singh on 08 March 2013.
Answer :- Through blood transfusion

Author :- Vijayankgca on 09 March 2013.
Answer :- trsn plasantal. or during parturation

Author :- Dr midacash on 09 March 2013.
Answer :- from blood trasfusion

Author :- HABIB PATHAN on 11 March 2013.
Answer :- congenital kala azar. Nearest differential is transfusion related which is unlikely here.

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