Malaria in children - experience from Asir region, Saudi Arabia.

During a five year period, 233 cases of malaria (2.4%) were diagnosed among 9259 children with fever and hepatosplenomegaly seen in Asir Central Hospital, Abha, Saudi Arabia. The majority of these were below four years of age and came from Tihama, a hot, humid valley area in the Asir region. The infection was seasonal and occurred between December and May. Apart from fever, vomiting and hepatosplenomegaly, anemia was a common clinical finding; this was partly due to iron deficiency anemia, probably nutritional. Most of the cases responded to chloroquine therapy; however, three required intravenous quinine and two received Fansidar to effect eradication of the parasitemia. During the study, two patients died, one from cerebral malaria and the other from severe hemolytic anemia and hemoglobinuria. For prevention of malaria in this endemic area, an integrated program is advocated that includes the use of bednets impregnated with permethin, adequate treatment of proven cases and intensive health education on malaria control and nutrition.

Clinical and laboratory features of childhood visceral leishmaniasis in southwestern Saudi Arabia.

The clinical and laboratory features of visceral leishmaniasis (VL) were studied in 51 children at Abha in southwestern Saudi Arabia, an area endemic for the disease. The majority of patients came from the coastal Tihama Valley or had visited the Valley from the hills. There was a predilection for infants and young children (median age 18 months). A double quotidian fever pattern was observed in half the patients. Splenomegaly was noted to be more common and more severe than hepatomegaly. Important hematological features were anemia, aften severe, neutropenia and thrombocytopenia. Common biochemical abnormalities inclueded hepatic dysfunction, hypoalbuminemia and hyperglobulinemia. The hematological and biochemical changes noted in VL are nonspecific. Our findings are compared with those from other endemic areas. Saudi Arabian VL resembles the Mediterranean form of the disease.

Diagnostic and management problems in childhood visceral leishmaniasis in south-western Saudi Arabia.

The diagnosis and management of childhood visceral leishmaniasis were studied in 51 parasitologically proven cases from Abha, Saudi Arabia. Bone marrow aspiration was positive in 40 of 47 cases (85%). Splenic aspiration, though rarely used because of perceived dangers, was not associated with complications and revealed the parasite in all 12 cases in which it was used. There was prompt response to sodium stibogluconate, with defervescence in 93% and decrease of hepatosplenomegaly in 67% of patients within 1 week of commencing chemotherapy. A dose of 20 mg/kg/day for at least 3 weeks was generally safe and effective in achieving cure and preventing relapse. Two children with persistent massive splenomegaly after the first course responded to prolonged chemotherapy. Bronchopneumonia and severe cytopenia were common complications. Disseminated intravascular coagulation and hepatitis were associated with a poor outcome. The four patients who died had a progressive course with multiple complications. Early detection and appropriate management of complications may help to reduce morbidity and mortality in childhood visceral leishmaniasis.