Is Visceral Leishmaniasis the same in HIV-coinfected adults?
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 si...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2018-03-01
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| Series: | Brazilian Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1413867017308796 |
| _version_ | 1818342452687273984 |
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| author | Guilherme Alves de Lima Henn Alberto Novaes Ramos Júnior Jeová Keny Baima Colares Lorena Pinho Mendes João Gabriel Colares Silveira Anderson Alberto Façanha Lima Bárbara Pontes Aires Mônica Cardoso Façanha |
| author_facet | Guilherme Alves de Lima Henn Alberto Novaes Ramos Júnior Jeová Keny Baima Colares Lorena Pinho Mendes João Gabriel Colares Silveira Anderson Alberto Façanha Lima Bárbara Pontes Aires Mônica Cardoso Façanha |
| author_sort | Guilherme Alves de Lima Henn |
| collection | DOAJ |
| description | 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. Keywords: Leishmaniasis, HIV, Coinfection |
| first_indexed | 2024-12-13T16:14:55Z |
| format | Article |
| id | doaj.art-456f252ca80d46f39eed62743d83cec7 |
| institution | Directory Open Access Journal |
| issn | 1413-8670 |
| language | English |
| last_indexed | 2024-12-13T16:14:55Z |
| publishDate | 2018-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Infectious Diseases |
| spelling | doaj.art-456f252ca80d46f39eed62743d83cec72022-12-21T23:38:51ZengElsevierBrazilian Journal of Infectious Diseases1413-86702018-03-012229298Is Visceral Leishmaniasis the same in HIV-coinfected adults?Guilherme Alves de Lima Henn0Alberto Novaes Ramos Júnior1Jeová Keny Baima Colares2Lorena Pinho Mendes3João Gabriel Colares Silveira4Anderson Alberto Façanha Lima5Bárbara Pontes Aires6Mônica Cardoso Façanha7Universidade Federal do Ceará, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, CE, Brazil; Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil; Corresponding author.Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, BrazilSecretaria de Saúde do Estado do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brazil; Universidade de Fortaleza, Faculdade de Medicina, Fortaleza, CE, BrazilSecretaria de Saúde do Estado do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, CE, BrazilUniversidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, BrazilUniversidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, BrazilUniversidade Estadual do Ceará, Faculdade de Medicina, Fortaleza, CE, BrazilUniversidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, BrazilIntroduction: 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. Keywords: Leishmaniasis, HIV, Coinfectionhttp://www.sciencedirect.com/science/article/pii/S1413867017308796 |
| spellingShingle | Guilherme Alves de Lima Henn Alberto Novaes Ramos Júnior Jeová Keny Baima Colares Lorena Pinho Mendes João Gabriel Colares Silveira Anderson Alberto Façanha Lima Bárbara Pontes Aires Mônica Cardoso Façanha Is Visceral Leishmaniasis the same in HIV-coinfected adults? Brazilian Journal of Infectious Diseases |
| title | Is Visceral Leishmaniasis the same in HIV-coinfected adults? |
| title_full | Is Visceral Leishmaniasis the same in HIV-coinfected adults? |
| title_fullStr | Is Visceral Leishmaniasis the same in HIV-coinfected adults? |
| title_full_unstemmed | Is Visceral Leishmaniasis the same in HIV-coinfected adults? |
| title_short | Is Visceral Leishmaniasis the same in HIV-coinfected adults? |
| title_sort | is visceral leishmaniasis the same in hiv coinfected adults |
| url | http://www.sciencedirect.com/science/article/pii/S1413867017308796 |
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