Clinical presentation and renal evaluation of human visceral leishmaniasis (kala-azar): a retrospective study of 57 patients in Brazil

Abstract

Visceral leishmaniasis is an endemic disease caused by various species of Leishmania. We made a retrospective study of 57 consecutive patients with visceral leishmaniasis in Brazil. Patients with visceral leishmaniasis were identified using the registries of the São José Infectious Diseases Hospital. The sample was divided into two groups: patients with serum creatinine (Scr) <1.3mg/dL and Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. We compared these two groups for differences in clinical manifestations and laboratory features. Patients' mean age was 28 ± 18 years old; 74% were male. The main clinical symptoms and signs presented in the initial evaluation were: fever (97%), splenomegaly (96.4%), weight loss (95.5%), pallor (93.6%), cough (89.7%), hepatomegaly (87.2%), asthenia (83.3%), anorexia (82.9%) and vomiting (73.9%). Acute renal failure was found in 15 patients (26.3%) and eight of these patients had ARF before amphotericin B administration. The mean age was higher in the group with Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. Death occurred in three cases; all deaths occurred with Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. There were no significant differences in the frequencies of the clinical symptoms and signs between the two groups. The laboratory data and demographic characteristics were significantly worse in the Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL group. Renal dysfunction is an important feature of this disease; it is associated with important morbidity and can increase mortality.

Risk Factors for Acute Kidney Injury in Visceral Leishmaniasis (Kala-Azar)

“…9 Lima Verde and others 14 in a cross-sectional study of 50 consecutive patients with visceral leishmaniasis, also carried out in our region, found a decreased glomerular filtration rate in 28% of the cases; this rate was attributed to fluid loss, volume contraction, and immunologic glomerular disease. In the present study, AKI was more frequent in male patients, and this is in accordance with previous studies.…”

“…In a previous study by our study group, the mortality rate was lower (5.2% of 57 study patients), and all deaths were associated with AKI. 9 A study of prognostic factors conducted in Northeastern Brazil verified that severe anemia, fever lasting > 60 days, diarrhea, and jaundice were risk factors for death in VL. 30 In the present study, the risk factors for mortality were amphotericin B use, oliguria, jaundice, and dyspnea.…”

Late diagnosis: a factor associated with death from visceral leishmaniasis in elderly patients

“…35 Conditions such as lymphadenomegaly, common in India and Sudan, were not found in the present study or elsewhere in Brazil 15,[36][37][38] -an important feature for differential diagnosis of myeloproliferative diseases. Splenomegaly, for instance -a classic sign of VL [30][31][32][33] and one of the clinic-epidemiological criteria for diagnosis 4 -was observed in v51% of the present sample, indicating that the criteria usually applied to patients over 60 years of age should be reviewed. Most patients had fever, although this symptom does not consistently manifest in elderly individuals under conditions that would typically elicit fever in younger patients.…”

“…Cough and diarrhoea have also been described. 23,[30][31][32][33][34] Among patients who died of the disease, Oliveira et al (2010) 11 found a lower occurrence of fever and splenomegaly than did the previously cited studies or an investigation of patients with VL-HIV co-infection. 35 Conditions such as lymphadenomegaly, common in India and Sudan, were not found in the present study or elsewhere in Brazil 15,[36][37][38] -an important feature for differential diagnosis of myeloproliferative diseases.…”

Subclinical tumor lysis-like syndrome during treatment of visceral leishmaniasis with low-dose intermittent liposomal amphotericin B

“…Typically it represents a lifethreatening disease with fever, cachexia, hepatosplenomegaly, pancytopenia, hypergammaglobulinaemia and hypoalbulinemia [1]. Renal dysfunction is an important feature of VL, associated with important morbidity and mortality [2]. Case reports and small case series have described renal involvement in VL appearing as glomerulonephritis and/or interstitial nephritis [3][4][5][6][7].…”