RESUMO
BACKGROUND AND METHODOLOGY: Due to geographic overlap of malaria and visceral leishmaniasis (VL), co-infections may exist but have been poorly investigated. To describe prevalence, features and risk factors for VL-malaria co-infections, a case-control analysis was conducted on data collected at Amudat Hospital, Uganda (2000-2006) by Médecins sans Frontières. Cases were identified as patients with laboratory-confirmed VL and malaria at hospital admission or during hospitalization; controls were VL patients with negative malaria smears. A logistic regression analysis was performed to study the association between patients' characteristics and the occurrence of the co-infection. RESULTS: Of 2414 patients with confirmed VL, 450 (19%) were positively diagnosed with concomitant malaria. Most co-infected patients were males, residing in Kenya (69%). While young age was identified by multivariate analysis as a risk factor for concurrent VL and malaria, particularly the age groups 0-4 (odds ratio (OR): 2.44; 95% confidence interval (CI): 1.52-3.92) and 5-9 years (OR: 2.23, 95% CI: 1.45-3-45), mild (OR: 0.53; 95% CI: 0.32-0.88) and moderate (OR: 0.45; 95% CI: 0.27-0.77) anemia negatively correlated with the co-morbidity. VL patients harboring skin infections were nearly three times less likely to have the co-infection (OR: 0.35; 95% CI: 0.17-0.72), as highlighted by the multivariate model. Anorexia was slightly more frequent among co-infected patients (OR: 1.71; 95% CI: 0.96-3.03). The in-hospital case-fatality rate did not significantly differ between cases and controls, being 2.7% and 3.1% respectively (OR: 0.87; 95% CI: 0.46-1.63). CONCLUSIONS: Concurrent malaria represents a common condition among young VL patients living in the Pokot region of Kenya and Uganda. Although these co-morbidities did not result in a poorer prognosis, possibly due to early detection of malaria, a positive trend towards more severe symptoms was identified, indicating that routine screening of VL patients living in malaria endemic-areas and close monitoring of co-infected patients should be implemented.
Assuntos
Coinfecção/epidemiologia , Leishmaniose Visceral/complicações , Leishmaniose Visceral/epidemiologia , Malária/complicações , Malária/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Coinfecção/mortalidade , Coinfecção/patologia , Feminino , Hospitais , Humanos , Lactente , Recém-Nascido , Leishmaniose Visceral/mortalidade , Leishmaniose Visceral/patologia , Malária/mortalidade , Malária/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Uganda/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To identify risk factors for in-hospital mortality in patients treated for visceral leishmaniasis (VL) in Uganda. METHODS: Retrospective analysis of VL patients' clinical data collected for project monitoring by Médecins Sans Frontières in Amudat, eastern Uganda. RESULTS: Between 2000 and 2005, of 3483 clinically suspect patients, 53% were confirmed with primary VL. Sixty-two per cent were children <16 years of age with a male/female ratio of 2.2. The overall case-fatality rate during pentavalent antimonial (n = 1641) or conventional amphotericin B treatment (n = 217) was 3.7%. There was no difference in the case-fatality rate between treatment groups (P > 0.20). The main risk factors for in-hospital death identified by a multivariate analysis were age <6 years and >15 years, concomitant tuberculosis or hepatopathy, and drug-related adverse events. The case-fatality rate among patients >45 years of age was strikingly high (29.0%). CONCLUSION: Subgroups of VL patients at higher risk of death during treatment with drugs currently available in Uganda were identified. Less toxic drugs should be evaluated and used in these patients.
Assuntos
Antiprotozoários/efeitos adversos , Mortalidade Hospitalar , Leishmaniose Visceral/mortalidade , Adolescente , Adulto , Antiprotozoários/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Leishmaniose Visceral/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Uganda/epidemiologia , Adulto JovemRESUMO
We estimated the pre-intervention prevalence of Trypanosoma brucei gambiense (Tbg) trypanosomiasis using the lot quality assurance sampling (LQAS) methods in 14 parishes of Terego County in northern Uganda. A total of 826 participants were included in the survey sample in 1996. The prevalence of laboratory confirmed Tbg trypanosomiasis adjusted for parish population sizes was 2.2% (95% confidence interval =1.1-3.2). This estimate was consistent with the 1.1% period prevalence calculated on the basis of cases identified through passive and active screening in 1996-1999. Ranking of parishes in four categories according to LQAS analysis of the 1996 survey predicted the prevalences observed during the first round of active screening in the population in 1997-1998 (P < 0.0001, by chi-square test). Overall prevalence and ranking of parishes obtained with LQAS were validated by the results of the population screening, suggesting that these survey methods may be useful in the pre-intervention phase of sleeping sickness control programs.
Assuntos
Garantia da Qualidade dos Cuidados de Saúde/métodos , Trypanosoma brucei gambiense/isolamento & purificação , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/parasitologia , Adolescente , Adulto , Testes de Aglutinação , Animais , Anticorpos Antiprotozoários/sangue , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Linfonodos/parasitologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Controle de Qualidade , População Rural , Tamanho da Amostra , Estudos de Amostragem , Estudos Soroepidemiológicos , Tripanossomíase Africana/sangue , Uganda/epidemiologiaRESUMO
In a clinical trial on efficacy of Pentamidine in second stage Trypanosoma brucei gambiense patients with =20 cells/microl in cerebrospinal fluid (CSF), 43% of treatment failures were observed. We hypothesised that unsuccessful treatment was caused by uncured brain infection. The relationship between treatment outcome and CSF cell count, protein concentration, presence of trypanosomes, the intrathecal immune response, and CSF total IgM and trypanosome specific antibodies detected by LATEX/IgM and LATEX/T.b. gambiense card agglutination tests was examined. Cell counts of 11-20 cells/microl, intrathecal IgM synthesis, CSF end-titres in LATEX/IgM >/=4 and LATEX/T.b. gambiense positive CSF, were associated with treatment failure. Detection of intrathecal IgM synthesis is valuable for assessment of brain involvement and treatment decision.