Visceral childhood leishmaniasis in Kag ˘ ızman, eastern Turkey: a new endemic area MUSTAFA BUYUKAVCI, MEHMET KARACAN, HUSEYIN TAN & RECEP AKDAG Department of Pediatrics, Faculty of Medicine, Ataturk University, Erzurum, Turkey (Accepted December 2004) Summary Visceral leishmaniasis is endemic in some areas of Turkey; however, it has not been reported previously from the eastern part of the country. We reviewed 21 cases of visceral leishmaniasis admitted from eastern Turkey, 60% of whom were from the same region, Kag ˘ızman. Introduction Visceral leishmaniasis (VL) is endemic in rural or peri-urban areas of the Mediterranean basin. Patients typically pre- sent with fever, hepatosplenomegaly and peripheral cytopenia, but variation of pre- senting symptoms has been reported in some geographic areas. 1 Cutaneous leish- maniasis is endemic in south-eastern and southern Turkey, and the visceral form is seen in the western, southern, northern and central provinces where the climate is relatively warm. 2–7 We present the clinical and laboratory features of cases of VL diagnosed in a new endemic area in eastern Turkey and compare them with other reports. Patients and Methods We retrospectively analysed 21 cases of childhood VL seen in the department of paediatrics of Ataturk University Faculty of Medicine between 1996 and 2002. Visceral leishmaniasis was diagnosed by demonstrating the amastigote forms of leish- mania in bone marrow aspiration smears. Results The median age of the 21 cases (12 girls, 9 boys) was 20 months (range 10–132). Fourteen (66%) children were admitted from the Kag ˘ızman region of Kars province (Fig. 1). Common presenting features were pallor (85%), fever (71%), anorexia (38%), abdominal distension (28%), purpuric rash (23%) and diarrhoea (14%). The median duration of symptoms was 30 days (range 7– 365). Physical findings at admission included splenomegaly (90%), hepatome- galy (57%), pre-tibial oedema (29%) and petechiae (19%). Twenty-four per cent and 10% were below the third percentile for weight-for-age and height-for-age, respec- tively. Laboratory findings were as follows: anaemia (95%), leucopenia (81%), throm- bocytopenia (100%) and pancytopenia (76%). Ninety per cent of children had reversal of the albumin:globulin ratio. Blood Reprint requests to: Dr Mustafa Buyukavci, Ataturk Universitesi Lojmanlari, 42/2 Erzurum, Turkey. Fax: z90 442 236 1301; e-mail: buyukavci@hotmail.com Annals of Tropical Paediatrics (2005) 25, 41–43 # 2005 The Liverpool School of Tropical Medicine DOI: 10.1179/146532805X23344