{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:11:28Z","timestamp":1791328288015,"version":"4.3.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"National Reference Center for Leishmaniasis in Montpellier"},{"name":"Sant\u00e9 Publique France"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Few studies have investigated the diagnosis and management of pediatric visceral leishmaniasis (VL) in high-income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All children hospitalized for VL in university hospitals across mainland France between January 2012 and August 2022 were included in this retrospective study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-three patients were included with an M\/F sex ratio of 1.25 and a median age of 2 years (IQR: 1; 5.4). At least 36 patients had autochthonous VL. The median delay between symptom onset and diagnosis was 20 days (IQR: 11.7; 35.2) [1\u2013193]. The most common symptoms were fever (92%) and splenomegaly (78%). Biological findings included inflammatory syndrome (90%), pancytopenia (79%), and hepatic cytolysis (52%). Twenty-four children (44%) presented hemophagocytic lymphohistiocytosis (HLH). Bone marrow smears, bone marrow real-time PCR (qPCR), and blood qPCR were positive for VL in 64%, 90%, and 96% of the tested patients, respectively. Positivity reached 100% in patients who underwent combined blood and bone marrow PCR. All the patients were treated with liposomal amphotericin B (chemical name, (1R,3S,5R,6R,9R,11R,15S,16R,17R,18S,19E,21E,23E,25E,27E,29E,31E,33R,35S,36R,37S)-33-[(2R,3S,4S,5S,6R)-4-amino-3,5-dihydroxy-6-methyloxan-2-yl]oxy-1,3,5,6,9,11,17,37-octahydroxy-15,16,18-trimethyl-13-oxo-14,39-dioxabicyclo[33.3.1]nonatriaconta-19,21,23,25,27,29,31-heptaene-36-carboxylic acid;2-aminoguanidine). Ten different regimens were used, ranging from 18 to 30\u2005mg\/kg cumulative doses given from 2 to 8 days. The median follow-up duration was 2.8 months. Four patients (6.3%) relapsed, one of whom was not retreated. All the children recovered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pediatric VL remains rare in France, with long diagnostic delays and a high frequency of HLH. The combination of blood and bone marrow PCR optimizes the diagnosis. Standardization of therapeutic regimens and follow-up is necessary.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf708","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T13:16:11Z","timestamp":1763558171000},"source":"Crossref","is-referenced-by-count":2,"title":["Diagnosis and Management of Visceral Leishmaniasis in Children: A French Retrospective Study"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2711-0185","authenticated-orcid":false,"given":"Justine","family":"de Larminat","sequence":"first","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Internal Medicine, Robert Debr\u00e9 Hospital, Assistance Publique\u2014H\u00f4pitaux de Paris , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na\u00efma","family":"Dahane","sequence":"additional","affiliation":[{"name":"Parasitology, Mycology, and Tropical Medicine, Cochin Hospital, Assistance Publique\u2014H\u00f4pitaux de Paris , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Argy","sequence":"additional","affiliation":[{"name":"Parasitology and Mycology, Bichat Hospital, Assistance Publique\u2014H\u00f4pitaux de Paris , Paris, France"},{"name":"IRDUMR 261\u2014INSERM 1344 MERIT, Faculty of Pharmacy, Paris Cit\u00e9 University , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Rifai","sequence":"additional","affiliation":[{"name":"General Pediatrics, Andr\u00e9 Mignot Hospital , Le Chesnay ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier Haas","family":"Ferrua","sequence":"additional","affiliation":[{"name":"Parasitology, Archet Site, University Hospital Center of Nice , Nice ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christelle","family":"Pomares","sequence":"additional","affiliation":[{"name":"Parasitology, Archet Site, University Hospital Center of Nice , Nice ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas Rasandisona","family":"Ravonjena","sequence":"additional","affiliation":[{"name":"Parasitology, University Hospital Center of Toulouse , Toulouse ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6992-1073","authenticated-orcid":false,"given":"Damien","family":"Dupont","sequence":"additional","affiliation":[{"name":"Institute of Infectious Agents, Hospices Civils , Lyon ,","place":["France"]},{"name":"Parasitology Medical Mycology, Croix-Rousse Hospital , Lyon ,","place":["France"]},{"name":"Integrative Physiology of the Brain Arousal Systems, Neurosciences Research Center, INSERM U1028-CNRS UMR 5292 , Lyon ,","place":["France"]},{"name":"Faculty of Medicine, Claude Bernard University Lyon 1 , Lyon ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Philippe","family":"Lemoine","sequence":"additional","affiliation":[{"name":"Infectious Agents Biology, University Hospital Center of Angers , Angers ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Dutron","sequence":"additional","affiliation":[{"name":"Pediatric Post-Emergency Department, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier , Montpellier ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Pineau","sequence":"additional","affiliation":[{"name":"Pediatric Post-Emergency Department, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier , Montpellier ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe Picherit","family":"Steinbrucker","sequence":"additional","affiliation":[{"name":"University Hospital Center of Guadeloupe , Pointe-\u00e0-Pitre, Guadeloupe ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thibault","family":"C\u00e9sar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Grenoble-Alpes University Hospital , Grenoble ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9homi","family":"Azohana","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Robert Debr\u00e9 University Hospital, CIC 1426 INSERM , Paris ,","place":["France"]},{"name":"ECEVE, INSERM 1123 , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Guilmin-Crepon","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Robert Debr\u00e9 University Hospital, CIC 1426 INSERM , Paris ,","place":["France"]},{"name":"ECEVE, INSERM 1123 , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Minodier","sequence":"additional","affiliation":[{"name":"General Pediatrics, Nord Hospital, Assistance Publique\u2014H\u00f4pitaux de Marseille , Marseille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Allouche","sequence":"additional","affiliation":[{"name":"General Pediatrics, Nord Hospital, Assistance Publique\u2014H\u00f4pitaux de Marseille , Marseille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathie","family":"Lorrot","sequence":"additional","affiliation":[{"name":"General Pediatrics and Post-Emergency, Armand Trousseau Hospital, Assistance Publique\u2014H\u00f4pitaux de Paris , Paris ,","place":["France"]},{"name":"Paris Sorbonne University , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Ravel","sequence":"additional","affiliation":[{"name":"French National Reference Center for Leishmaniasis, University Hospital Center of Montpellier, University of Montpellier , Montpellier ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Faye","sequence":"additional","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Internal Medicine, Robert Debr\u00e9 Hospital, Assistance Publique\u2014H\u00f4pitaux de Paris , Paris ,","place":["France"]},{"name":"ECEVE, INSERM 1123 , Paris ,","place":["France"]},{"name":"Paris Cit\u00e9 University , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"2025120210512620400_ofaf708-B1","author":"World Health Organization"},{"key":"2025120210512620400_ofaf708-B2","doi-asserted-by":"crossref","first-page":"e0010745","DOI":"10.1371\/journal.pntd.0010745","article-title":"Leishmaniasis epidemiology in endemic areas of metropolitan France and its overseas territories from 1998 to 2020","volume":"16","author":"Pasquier","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"2025120210512620400_ofaf708-B3","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.1542\/peds.106.4.e58","article-title":"Hemophagocytic syndrome: a misleading complication of visceral leishmaniasis in children\u2014a series of 12 cases","volume":"106","author":"Gagnaire","year":"2000","journal-title":"Pediatrics"},{"key":"2025120210512620400_ofaf708-B4","doi-asserted-by":"crossref","first-page":"e223","DOI":"10.1097\/MPH.0000000000001747","article-title":"A brief report and mini-review of visceral leishmaniasis-associated hemophagocytic lymphohistiocytosis in children","volume":"43","author":"Mantadakis","year":"2021","journal-title":"J Pediatr Hematol Oncol"},{"key":"2025120210512620400_ofaf708-B5","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.cellimm.2014.08.004","article-title":"Leishmaniasis and autoimmune diseases in pediatric age","volume":"292","author":"Nozzi","year":"2014","journal-title":"Cell Immunol"},{"key":"2025120210512620400_ofaf708-B6","doi-asserted-by":"crossref","first-page":"5249","DOI":"10.1128\/JCM.42.11.5249-5255.2004","article-title":"Quantification of Leishmania infantum DNA by a real-time PCR assay with high sensitivity","volume":"42","author":"Mary","year":"2004","journal-title":"J Clin Microbiol"},{"key":"2025120210512620400_ofaf708-B7","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.patbio.2008.03.007","article-title":"Les cultures sur milieu NNN dans le diagnostic biologique des leishmanioses","volume":"57","author":"Chouihi","year":"2009","journal-title":"Pathol Biol (Paris)"},{"key":"2025120210512620400_ofaf708-B8","author":"Hentgen"},{"key":"2025120210512620400_ofaf708-B9","doi-asserted-by":"crossref","first-page":"2308","DOI":"10.1182\/blood.2024025077","article-title":"Diagnostic guidelines for familial hemophagocytic lymphohistiocytosis revisited","volume":"144","author":"Henter","year":"2024","journal-title":"Blood"},{"key":"2025120210512620400_ofaf708-B10","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1093\/jpids\/piz055","article-title":"Congenital leishmaniasis in a newborn infant whose mother was coinfected with leishmaniasis and HIV","volume":"9","author":"Argy","year":"2020","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2025120210512620400_ofaf708-B11","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/INF.0000000000003086","article-title":"Distinct laboratory and clinical features of secondary hemophagocytic lymphohistiocytosis in pediatric visceral leishmaniasis: a retrospective analysis of 127 children in Andalusia, Spain (2004-2019)","volume":"40","author":"L\u00f3pez Marcos","year":"2021","journal-title":"Pediatr Infect Dis J"},{"key":"2025120210512620400_ofaf708-B12","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s40249-024-01204-5","article-title":"Epidemiological and clinical trends of visceral leishmaniasis in Portugal: retrospective analysis of cases diagnosed in public hospitals between 2010 and 2020","volume":"13","author":"Rocha","year":"2024","journal-title":"Infect Dis Poverty"},{"key":"2025120210512620400_ofaf708-B13","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3390\/pathogens13030205","article-title":"Autochthonous and imported visceral leishmaniasis in Bulgaria\u2014clinical experience and treatment of patients","volume":"13","author":"Vutova","year":"2024","journal-title":"Pathogens"},{"key":"2025120210512620400_ofaf708-B14","author":"Cours"},{"key":"2025120210512620400_ofaf708-B15","doi-asserted-by":"crossref","first-page":"e0011497","DOI":"10.1371\/journal.pntd.0011497","article-title":"The estimated distribution of autochthonous leishmaniasis by Leishmania infantum in Europe in 2005\u20132020","volume":"17","author":"Maia","year":"2023","journal-title":"PLoS Negl Trop Dis"},{"key":"2025120210512620400_ofaf708-B16","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1136\/ard.2003.014480","article-title":"Visceral leishmaniasis resembling systemic lupus erythematosus","volume":"63","author":"Voulgari","year":"2004","journal-title":"Ann Rheum Dis"},{"key":"2025120210512620400_ofaf708-B17","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jinf.2015.03.002","article-title":"Cryoglobulinemic purpura in visceral leishmaniasis","volume":"71","author":"Petraki","year":"2015","journal-title":"J Infect"},{"key":"2025120210512620400_ofaf708-B18","author":"Masson"},{"key":"2025120210512620400_ofaf708-B19","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.bjid.2012.10.017","article-title":"Congenitally transmitted visceral leishmaniasis: report of two Brazilian human cases","volume":"17","author":"Mescouto-Borges","year":"2013","journal-title":"Braz J Infect Dis"},{"key":"2025120210512620400_ofaf708-B20","doi-asserted-by":"crossref","first-page":"e1005302","DOI":"10.1371\/journal.ppat.1005302","article-title":"A mother's gift: congenital transmission of trypanosoma and leishmania species","volume":"12","author":"Grinnage-Pulley","year":"2016","journal-title":"PLoS Pathog"},{"key":"2025120210512620400_ofaf708-B21","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/j.arcped.2013.08.003","article-title":"La leishmaniose visc\u00e9rale infantile, une cause de syndrome d\u2019h\u00e9mophagocytose lympho-histiocytaire facilement curable","volume":"20","author":"Visentin","year":"2013","journal-title":"Arch Pediatr"},{"key":"2025120210512620400_ofaf708-B22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.mam.2016.11.012","article-title":"Leishmania infections: molecular targets and diagnosis","volume":"57","author":"Akhoundi","year":"2017","journal-title":"Mol Aspects Med"},{"key":"2025120210512620400_ofaf708-B23","doi-asserted-by":"crossref","first-page":"858","DOI":"10.4269\/ajtmh.2006.75.858","article-title":"Reference values for Leishmania infantum parasitemia in different clinical presentations: quantitative polymerase chain reaction for therapeutic monitoring and patient follow-up","volume":"75","author":"Mary","year":"2006","journal-title":"Am J Trop Med Hyg"},{"key":"2025120210512620400_ofaf708-B24","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1093\/cid\/ciab124","article-title":"Blood parasite load as an early marker to predict treatment response in visceral leishmaniasis in Eastern Africa","volume":"73","author":"Verrest","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2025120210512620400_ofaf708-B25","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.diagmicrobio.2014.01.031","article-title":"Parasite load estimation by qPCR differentiates between asymptomatic and symptomatic infection in Indian visceral leishmaniasis","volume":"80","author":"Sudarshan","year":"2014","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2025120210512620400_ofaf708-B26","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1016\/S0929-693X(10)70137-8","article-title":"Le traitement des leishmanioses","volume":"17","author":"Minodier","year":"2010","journal-title":"Arch Pediatr"},{"key":"2025120210512620400_ofaf708-B27","doi-asserted-by":"crossref","first-page":"e202","DOI":"10.1093\/cid\/ciw670","article-title":"Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)","volume":"63","author":"Aronson","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2025120210512620400_ofaf708-B28","doi-asserted-by":"crossref","first-page":"93","DOI":"10.4269\/ajtmh.14-0657","article-title":"Short-course treatment regimen of Indian visceral leishmaniasis with an Indian liposomal amphotericin B preparation (Fungisome\u2122)","volume":"94","author":"Goswami","year":"2016","journal-title":"Am J Trop Med Hyg"},{"key":"2025120210512620400_ofaf708-B29","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1086\/367843","article-title":"Two doses of a lipid formulation of amphotericin B for the treatment of Mediterranean visceral leishmaniasis","volume":"36","author":"Syriopoulou","year":"2003","journal-title":"Clin Infect Dis"},{"key":"2025120210512620400_ofaf708-B30","author":"WHO\/Regional office for Europe"},{"key":"2025120210512620400_ofaf708-B31","doi-asserted-by":"crossref","first-page":"e0008429","DOI":"10.1371\/journal.pntd.0008429","article-title":"Long-term incidence of relapse and post-kala-azar dermal leishmaniasis after three different visceral leishmaniasis treatment regimens in Bihar, India","volume":"14","author":"Goyal","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"2025120210512620400_ofaf708-B32","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.ijid.2020.02.028","article-title":"Predictors of relapse of visceral leishmaniasis in inner S\u00e3o Paulo state, Brazil","volume":"95","author":"Sim\u00e3o","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2025120210512620400_ofaf708-B33","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1186\/s12879-016-1746-1","article-title":"Safety and efficacy of liposomal amphotericin B for treatment of complicated visceral leishmaniasis in patients without HIV, North-West Ethiopia","volume":"16","author":"Tamiru","year":"2016","journal-title":"BMC Infect Dis"},{"key":"2025120210512620400_ofaf708-B34","first-page":"25","article-title":"Efficacy and safety of liposomal amphotericin B (AmBisome) for visceral leishmaniasis in endemic developing countries","volume":"76","author":"Berman","year":"1998","journal-title":"Bull World Health Organ"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofaf708\/65415394\/ofaf708.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/12\/ofaf708\/65415394\/ofaf708.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/12\/ofaf708\/65415394\/ofaf708.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T15:51:40Z","timestamp":1764690700000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaf708\/8332159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":34,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,11,26]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaf708","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,11,20]]},"article-number":"ofaf708"}}