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Is Visceral Leishmaniasis the same in HIV-coinfected adults?
Henn, Guilherme Alves de Lima; Ramos Júnior, Alberto Novaes; Colares, Jeová Keny Baima; Mendes, Lorena Pinho; Silveira, João Gabriel Colares; Lima, Anderson Alberto Façanha; Aires, Bárbara Pontes; Façanha, Mônica Cardoso.
  • Henn, Guilherme Alves de Lima; Universidade Federal do Ceará. Programa de Pós-Graduação em Saúde Coletiva. Fortaleza. BR
  • Ramos Júnior, Alberto Novaes; Universidade Federal do Ceará. Departamento de Saúde Comunitária. Fortaleza. BR
  • Colares, Jeová Keny Baima; Secretaria de Saúde do Estado do Ceará. Hospital São José de Doenças Infecciosas. Fortaleza. BR
  • Mendes, Lorena Pinho; Secretaria de Saúde do Estado do Ceará. Hospital São José de Doenças Infecciosas. Fortaleza. BR
  • Silveira, João Gabriel Colares; Universidade Federal do Ceará. Faculdade de Medicina. Fortaleza. BR
  • Lima, Anderson Alberto Façanha; Universidade Federal do Ceará. Faculdade de Medicina. Fortaleza. BR
  • Aires, Bárbara Pontes; Universidade Estadual do Ceará. Faculdade de Medicina. Fortaleza. BR
  • Façanha, Mônica Cardoso; Universidade Federal do Ceará. Departamento de Saúde Comunitária. Fortaleza. BR
Braz. j. infect. dis ; 22(2): 92-98, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-951638
ABSTRACT
ABSTRACT

Introduction:

Visceral Leishmaniasis is the most severe form of disease caused by the Leishmania donovani complex, with significant morbidity and mortality in developing countries. Worse outcomes occur among HIV-positive individuals coinfected with Leishmania. It is unclear, however, if there are significant differences on presentation between Visceral Leishmaniasis patients with or without HIV coinfection.

Methods:

We reviewed medical records from adult patients with Visceral Leishmaniasis treated at a reference healthcare center in Fortaleza - Ceará, Brazil, from July 2010 to December 2013. Data from HIV-coinfected patients have been abstracted and compared to non-HIV controls diagnosed with Visceral Leishmaniasis in the same period.

Results:

Eighty one HIV-infected patients and 365 controls were enrolled. The diagnosis in HIV patients took significantly longer, with higher recurrence and death rates. Kala-azar's classical triad (fever, constitutional symptoms and splenomegaly) was less frequently observed in Visceral Leishmaniasis-HIV patients, as well as jaundice and edema, while diarrhea was more frequent. Laboratory features included lower levels of hemoglobin, lymphocyte counts and liver enzymes, as well as higher counts of blood platelets and eosinophils. HIV-infected patients were diagnosed mainly through amastigote detection on bone marrow aspirates and treated more often with amphotericin B formulations, whereas in controls, rK39 was the main diagnostic tool and pentavalent antimony was primarily used for treatment.

Conclusions:

Clinical and laboratory presentation of Visceral Leishmaniasis in HIV-coinfected patients may differ from classic kala-azar, and these differences may be, in part, responsible for the delay in diagnosing and treating leishmaniasis, which might lead to worse outcomes.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: AIDS-Related Opportunistic Infections / Leishmaniasis, Visceral Type of study: Diagnostic study / Observational study / Prevalence study / Risk factors Limits: Adolescent / Adult / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Braz. j. infect. dis Journal subject: Communicable Diseases Year: 2018 Type: Article Affiliation country: Brazil Institution/Affiliation country: Secretaria de Saúde do Estado do Ceará/BR / Universidade Estadual do Ceará/BR / Universidade Federal do Ceará/BR

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Full text: Available Index: LILACS (Americas) Main subject: AIDS-Related Opportunistic Infections / Leishmaniasis, Visceral Type of study: Diagnostic study / Observational study / Prevalence study / Risk factors Limits: Adolescent / Adult / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Braz. j. infect. dis Journal subject: Communicable Diseases Year: 2018 Type: Article Affiliation country: Brazil Institution/Affiliation country: Secretaria de Saúde do Estado do Ceará/BR / Universidade Estadual do Ceará/BR / Universidade Federal do Ceará/BR