Objectives. To identify factors associated with death in visceral leishmaniasis (VL) cases. Patients and Methodology. We evaluated prognostic factors for death from VL in São Paulo state, Brazil, from 1999 to 2005. A prognostic study nested in a clinical cohort was carried out by data analysis of 376 medical files. A comparison between VL fatal cases and survivors was performed for clinical, laboratory, and biological features. Association between variables and death was assessed by univariate analysis, and the multiple logistic regression model was used to determine adjusted odds ratio for death, controlling confounding factors. Results. Data analysis identified 53 fatal cases out of 376 patients, between 1999 and 2005 in São Paulo state. Lethality was 14.1% (53/376), being higher in patients older than fifty years. The main causes of death were sepsis, bleeding, liver failure, and cardiotoxicity due to treatment. Variables significantly associated with death were severe anemia, bleeding, heart failure, jaundice, diarrhea, fever for more than sixty days, age older than fifty years, and antibiotic use. Conclusion. Educational health measures are needed for the general population and continuing education programs for health professionals working in the affected areas with the purpose of identifying and treating early cases, thus preventing the disease evolution towards death.
Background: Visceral Leishmaniasis and Human Immunodeficiency Virus co-infection (VL-HIV) occurs mainly in risk groups for HIV/AIDS (youth adult males). These co-infected individuals have greater mortality and relapses rates compared to VL as they share similar immune pathogenic mechanisms. Interest in co-infection VL/HIV and the lack of data in the literature led the authors to a survey on the subject comparing outcomes in VL-HIV co-infected treated with different drugs anti-Leishmania used in Brazil, such that Pentavalent Antimoniate (MA), Amphotericin B deoxicolate (AmBd), and liposomal Amphotericin B (LAmB).Methods: A retrospective descriptive study using routine program data was performed comparing drugs used for treatment of co-infected patients in Sao Paulo state, Brazil, among 1999-2010, observing their outcomes (cure, failure, relapse or death), and analyzing them by each drug used.Results: In the period of twelve years were reported 1,614 VL cases in Sao Paulo state from whom 1 070 (66.30%) were HIV-negative, 117 (7.25%) were HIV-positive and in 427 patients (26.45%) HIV status was unknown. To compare treatment response according to drugs used, we included only the 117 VL/HIV co-infected patients. Related to demographic data we found 72.65% (85/117) of males and 80.34% (94/117) of young adults (21-50 years old). From 117 co-infected patients, 95 had complete data of the treatment performed and these were included in the analysis. The lethality of VL-HIV co-infected patients was 24.2% (23/95) and general relapse rate was 10.5% (10/95). Deaths in co-infected were more prevalent among 31-50 years. According to drug used, 35.64% (36/101) were treated with pentavalent antimoniate (20 mg/kg/day per 28 days), 12 (11%) received Amphotericin B deoxicolate (AmBd) (total dose: 20 to 24 mg/kg) and 47 were treated with Liposomal amphotericin B (LAmB) (total dose: 20 to 24 mg/kg). Patients treated with PA presented similar cure rates compared to LAmB. Patients treated with AmBd had higher lethality and patients treated with LAmB had no failures. Conclusion:High lethality and relapses rates occur in VL-HIV co-infected patients. Poor outcome leading to death was observed in AmBd group. There is an urgent necessity to perform prospective clinical trials to evaluate the safety and efficacy of different schemes for treatment of co-infected patients, especially in New World.
Background: Visceral Leishmaniasis and Human Immunodeficiency Virus co-infection (VL-HIV) occurs mainly in risk groups for HIV/AIDS (youth adult males). These co-infected individuals have greater mortality and relapses rates compared to VL as they share similar immune pathogenic mechanisms. Interest in co-infection VL/HIV and the lack of data in the literature led the authors to a survey on the subject comparing outcomes in VL-HIV co-infected treated with different drugs anti-Leishmania used in Brazil, such that Pentavalent Antimoniate (MA), Amphotericin B deoxicolate (AmBd), and liposomal Amphotericin B (LAmB).Methods: A retrospective descriptive study using routine program data was performed comparing drugs used for treatment of co-infected patients in Sao Paulo state, Brazil, among 1999-2010, observing their outcomes (cure, failure, relapse or death), and analyzing them by each drug used.Results: In the period of twelve years were reported 1,614 VL cases in Sao Paulo state from whom 1 070 (66.30%) were HIV-negative, 117 (7.25%) were HIV-positive and in 427 patients (26.45%) HIV status was unknown. To compare treatment response according to drugs used, we included only the 117 VL/HIV co-infected patients. Related to demographic data we found 72.65% (85/117) of males and 80.34% (94/117) of young adults (21-50 years old). From 117 co-infected patients, 95 had complete data of the treatment performed and these were included in the analysis. The lethality of VL-HIV co-infected patients was 24.2% (23/95) and general relapse rate was 10.5% (10/95). Deaths in co-infected were more prevalent among 31-50 years. According to drug used, 35.64% (36/101) were treated with pentavalent antimoniate (20 mg/kg/day per 28 days), 12 (11%) received Amphotericin B deoxicolate (AmBd) (total dose: 20 to 24 mg/kg) and 47 were treated with Liposomal amphotericin B (LAmB) (total dose: 20 to 24 mg/kg). Patients treated with PA presented similar cure rates compared to LAmB. Patients treated with AmBd had higher lethality and patients treated with LAmB had no failures. Conclusion:High lethality and relapses rates occur in VL-HIV co-infected patients. Poor outcome leading to death was observed in AmBd group. There is an urgent necessity to perform prospective clinical trials to evaluate the safety and efficacy of different schemes for treatment of co-infected patients, especially in New World.
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