Is splenectomy an option for multiple relapses in a child with visceral leishmaniasis? A case report

Campos, Marcos Adriano Garcia; Filho, Andrey Salgado Moraes; Rêgo, Gustavo Ribeiro Féres Moraes; Silva, Raphael Oliveira Lima; Sousa, Rebeca Aranha Barbosa; Tchuisseu, Yolande Pokam; Silva, Gyl Eanes Barros; Gama, Mônica Elinor Alves

doi:10.1590/0037-8682-0748-2020

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…Generally, the benefits of splenectomy in patients with VL are not well defined. Removing the large amounts of parasites is one of the potential benefits as, in the presence of severe splenomegaly, the levels of drugs in the spleen for the treatment of VL may not be sufficiently high to eradicate the parasite and cure the disease [36,37]. Some authors also suggest a splenectomy in patients with recurrent VL [37,38].…”

Section: Discussionmentioning

confidence: 99%

Splenectomy for Visceral Leishmaniasis Out of an Endemic Region: A Case Report and Literature Review

et al. 2022

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Visceral leishmaniasis (also known as kala-azar) is characterized by fever, weight loss, swelling of the spleen and liver, and pancytopenia. If it is not treated, the fatality rate in developing countries can be as high as 100% within 2 years. In a high risk situation for perioperative bleeding due to severe thrombocytopenia/coagulopathy, we present a rare challenge for urgent splenectomy in a patient with previously undiagnosed visceral leishmaniasis. A histologic examination of the spleen revealed a visceral leishmaniasis, and the patient was successfully treated with amphotericin B.

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Section: Discussionmentioning

confidence: 99%

Splenectomy for Visceral Leishmaniasis Out of an Endemic Region: A Case Report and Literature Review

et al. 2022

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In Vitro Drug Susceptibility of a Leishmania (Leishmania) infantum Isolate from a Visceral Leishmaniasis Pediatric Patient after Multiple Relapses

et al. 2023

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The parasitic protozoan Leishmania (Leishmania) infantum is the etiological agent of human visceral leishmaniasis in South America, an infectious disease associated with malnutrition, anemia, and hepatosplenomegaly. In Brazil alone, around 2700 cases are reported each year. Treatment failure can occur as a result of drug, host, and/or parasite-related factors. Here, we isolated a Leishmania species from a pediatric patient with visceral leishmaniasis that did not respond to chemotherapy, experiencing a total of nine therapeutic relapses and undergoing a splenectomy. The parasite was confirmed as L. (L.) infantum after sequencing of the ribosomal DNA internal transcribed spacer, and the clinical isolate, in both promastigote and amastigote forms, was submitted to in vitro susceptibility assays with all the drugs currently used in the chemotherapy of leishmaniasis. The isolate was susceptible to meglumine antimoniate, amphotericin B, pentamidine, miltefosine, and paromomycin, similarly to another strain of this species that had previously been characterized. These findings indicate that the multiples relapses observed in this pediatric patient were not due to a decrease in the drug susceptibility of this isolate; therefore, immunophysiological aspects of the patient should be further investigated to understand the basis of treatment failure in this case.

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Systematic Review of Treatment Failure and Clinical Relapses in Leishmaniasis from a Multifactorial Perspective: Clinical Aspects, Factors Associated with the Parasite and Host

Santos,

Sousa,

Aguiar

et al. 2023

TropicalMed

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Leishmaniasis is a disease caused by protozoa of the genus Leishmania. Treatment options are limited, and there are frequent cases of treatment failure and clinical relapse. To understand these phenomena better, a systematic review was conducted, considering studies published between 1990 and 2021 in Portuguese, English, and Spanish. The review included 64 articles divided into three categories. Case reports (26 articles) focused on treatment failure and clinical relapse in cutaneous leishmaniasis patients (47.6%), primarily affecting males (74%) and children (67%), regardless of the clinical manifestation. Experimental studies on the parasite (19 articles), particularly with L. major (25%), indicated that alterations in DNA and genic expression (44.82%) played a significant role in treatment failure and clinical relapse. Population data on the human host (19 articles) identified immunological characteristics as the most associated factor (36%) with treatment failure and clinical relapse. Each clinical manifestation of the disease presented specificities in these phenomena, suggesting a multifactorial nature. Additionally, the parasites were found to adapt to the drugs used in treatment. In summary, the systematic review revealed that treatment failure and clinical relapse in leishmaniasis are complex processes influenced by various factors, including host immunology and parasite adaptation.

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Is splenectomy an option for multiple relapses in a child with visceral leishmaniasis? A case report

Cited by 3 publications

References 10 publications

Splenectomy for Visceral Leishmaniasis Out of an Endemic Region: A Case Report and Literature Review

Splenectomy for Visceral Leishmaniasis Out of an Endemic Region: A Case Report and Literature Review

In Vitro Drug Susceptibility of a Leishmania (Leishmania) infantum Isolate from a Visceral Leishmaniasis Pediatric Patient after Multiple Relapses

Systematic Review of Treatment Failure and Clinical Relapses in Leishmaniasis from a Multifactorial Perspective: Clinical Aspects, Factors Associated with the Parasite and Host

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