RESUMO
During last decades significant attention has been paid to the increase of protozoal infections including leishmaniasis. The management of this disease is rather problematic. Significant increase of cases of this disease was observed in Georgia as well. The problem of visceral leishmaniasis is very important nowadays. According to references and our clinical experience patients with visceral leishmaniasis are predisposed to bleeding. The objective of our study was the assessment of functional status of hemostasis in patients with visceral leishmaniasis. We have studied the intravascular activation markers of blood coagulation -- the soluble fibrin-monomeric complexes (SFMC) and fibrinogen/fibrin degradation products (D-dimer) in order to reveal the disorders of hemocoagulation. SFMC and D-dimer we studied in 45 patients with visceral leishmaniasis before and after treatment (with 20-25 day intervals). One patient with severe generalized bleeding died within 72 hours of admission. SFMC measurements were conducted by the orthophenantroline test (Renam, Russia). D-dimer level was measured using FDP-Slidex Direct kit (Bio-Meriou, France). Especially high levels of SFMC and D-dimer have been revealed in cases of severe form of visceral leishmaniasis. SFMC level was increased by 80% (p=0,003), and D-dimer level by 95,6% (p=0,023). There was correlation between numbers of platelets and intravascular blood coagulation markers. Investigation of SFMC and D-dimer showed that in case of visceral leishmaniasis activation of intravascular coagulation takes place, particularly during the severe forms of the disease. Study of these markers is of the diagnostic and prognostic importance and for the initiation of treatment at an early stage of infection, which may potentially avoid the possibility of developing an uncompensated DIC.
