IMPORTED AND AUTOCHTHONOUS KALA-AZAR IN FRANCE

Objective - To study the epidemiological, clinical, and biological features of imported and autochthonous kala-azar in France. Design-Prospective survey of all patients in France with kala-azar diagnosed over the two years 1986-7. Information was obtained from parasitology laboratories in regional hospitals and all hospital laboratories and haematology departments capable of diagnosing leishmaniasis in the south of France. Setting-107 public hospitals in France. Patients-89 patients with kala-azar. Interventions-All patients were treated with drugs. In the first instance meglumine antimonate was given to all but two patients. Main outcome measures-Prevalence of the various clinical and biological features of kala-azar; proportion of patients with HIV infection. Results-Half (44) of the patients were children under 8 years old. Seventy patients acquired the disease in France. Imported kala-azar was acquired mainly in Mediterranean countries (9/18 cases). Only 46 (52%) of the patients had all three of the classic associated clinical features of fever, splenomegaly, and hepatomegaly. Anaemia was the commonest biological sign, and the association of the four usual biological signs-anaemia, leucopenia, thrombocytopenia, and hypergammaglobulinaemia -was present in only 14 (33%) of the children under 8 and 26 (60%) adults. Fourteen of the patients over 8 years old were infected with HIV. Conclusion-Doctors must be aware of kala-azar in Mediterranean areas, especially as patients often present without the characteristic features and the disease affects young children preferentially.