Parasite load and risk factors for poor outcome among children with visceral leishmaniasis. A cohort study in Belo Horizonte, Brazil, 2010-2011

Mourão, Maria Vitória Assumpção; Toledo, Antonio; Gomes, Luciana I.; Freire, Verônica Vieira; Rabello, Ana

doi:10.1590/0074-0276140257

Cited by 12 publications

(16 citation statements)

References 28 publications

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“…This can be easily explained by the pathophysiology of the two diseases, as both HIV and VL lead to a compromised immune status in the patient and poor treatment outcomes [5,16,21]. …”

Section: Discussionmentioning

confidence: 99%

Visceral leishmaniasis treatment outcome and its determinants in northwest Ethiopia

2016

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OBJECTIVESPoor treatment outcomes of visceral leishmaniasis (VL) are responsible for the high mortality rate of this condition in resource-limited settings such as Ethiopia. This study aimed to identify the proportion of poor VL treatment outcomes in northwest Ethiopia and to evaluate the determinants associated with poor outcomes.METHODSA hospital-based retrospective study was conducted among 595 VL patients who were admitted to Kahsay Abera Hospital in northwest Ethiopia from October 2010 to April 2013. Data were entered into Epi Info version 7.0 and exported to SPSS version 20 for analysis. Bivariate and multivariate logistic regression models were fitted to identify the determinants of VL treatment outcomes. Adjusted odds ratio (aORs) with 95% confidence intervals (CIs) were used, and p-values <0.05 were considered to indicate statistical significance.RESULTSThe proportion of poor treatment outcomes was 23.7%. Late diagnosis (≥29 days) (aOR, 4.34; 95% CI, 2.22 to 8.46), severe illness at admission (inability to walk) (aOR, 1.63; 95% CI, 1.06 to 2.40) and coinfection with VL and human immunodeficiency virus (HIV) (aOR, 2.72; 95% CI, 1.40 to 5.20) were found to be determinants of poor VL treatment outcomes.CONCLUSIONSPoor treatment outcomes, such as death, treatment failure, and non-adherence, were found to be common. Special attention must be paid to severely ill and VL/HIV-coinfected patients. To improve VL treatment outcomes, the early diagnosis and treatment of VL patients is recommended.

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“…This can be easily explained by the pathophysiology of the two diseases, as both HIV and VL lead to a compromised immune status in the patient and poor treatment outcomes [5,16,21]. …”

Section: Discussionmentioning

confidence: 99%

Visceral leishmaniasis treatment outcome and its determinants in northwest Ethiopia

2016

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“…Leishmania burdens in treated VL patients generally decline during treatment (reviewed by Kip et al, 2014; see also Pourabbas et al, 2013;Mourão et al, 2014;Mary et al, 2004Mary et al, , 2006Aoun et al, 2009;Sudarshan et al, 2011). However inadequate drugs, doses and durations may result in parasite persistence (e.g.…”

Section: Parasite Loads In Response To Treatmentmentioning

confidence: 99%

“…Pourabbas et al (2013); Mourão et al (2014)), and even in KA patients considered clinically cured without recorded relapse, residual parasites may persist e.g. in 11/21 Iranian patients treated with antimony (Glucantime) Pourabbas et al, 2013; 2/6 patients treated with SAG (Verma et al, 2010), and 4/48 Brazil children under various treatment regimes (Mourão et al, 2014).…”

Section: Parasite Loads In Response To Treatmentmentioning

confidence: 99%

Progress in the Mathematical Modelling of Visceral Leishmaniasis

Rock¹,

Quinnell²,

Medley³

et al. 2016

Mathematical Models for Neglected Tropical Diseases - Essential Tools for Control and Elimination, Part B

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The leishmaniases comprise a complex of diseases characterised by clinical outcomes that range from self-limiting to chronic, disfiguring and stigmatising, to life-threatening. Diagnostic methods, treatments, and vector and reservoir control options exist, but deciding the most effective interventions requires a quantitative understanding of the population level infection and disease dynamics. The effectiveness of any set of interventions has to be determined within the context of operational conditions, including economic and political commitment. Mathematical models are the best available tools for studying quantitative systems crossing disciplinary spheres (biology, medicine, economics) within environmental and societal constraints.In 2005, the World Health Assembly and government health ministers of India, Nepal, and Bangladesh signed a Memorandum of Understanding to eliminate the life threatening form of leishmaniasis, visceral leishmaniasis (VL), on the Indian subcontinent by 2015 through a combination of early case detection, improved treatments, and vector control. The elimination target is <1/10,000 population at the district or subdistrict level compared to the current 20/10,000 in the regions of highest transmission.Towards this goal, this chapter focuses on mathematical models of VL, and the biology driving those models, to enable realistic predictions of the * Corresponding author Email address: orin.courtenay@warwick.ac.uk (Orin Courtenay)Preprint submitted to Advances in Parasitology July 18, 2016 best combination of interventions. Several key issues will be discussed which have affected previous modelling of VL and the direction future modelling may take. Current understanding of the natural history of disease, immunity (and loss of immunity), as well as stages of infection and their durations are considered particularly for humans, but also for dogs. Asymptomatic and clinical infection are discussed in the context of their relative roles in Leishmania transmission, as well as key components of the parasite-sandfly-vector interaction and intervention strategies including diagnosis, treatment and vector control. Gaps in current biological knowledge and potential avenues to improve model structures and mathematical predictions are identified. Underpinning the marriage between biology and mathematical modelling, the content of this chapter represents the first step towards developing the next generation of models for VL.

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“…This is because the disease is more prevalent in Kola to Weina Dega agro-ecological zones of Ethiopia, areas where major agricultural projects exist. 12 Predictors of mortality among VL patients include presence of drug toxicity, 13 malnutrition, 3,14,15 VL-HIV co-infection, 5,8,[15][16][17][18][19][20][21][22] thrombocytopenia, 5,10,[16][17][18][19]23 leukopenia, 5,[16][17][18][19]24 jaundice, 5,[16][17][18][19]24 relapsing course of the disease, 10,20,23 high parasite load, [25][26][27] renal failure (creatinine >1.5 mg/dl), 18,24 diarrhea, 9,10,23 nasal bleeding, 5,9,[16]…”

Section: Introductionmentioning

confidence: 99%

<p>Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study</p>

Yeshaw¹,

Tsegaye²,

Nigatu³

2020

IDR

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Background: Visceral leishmaniasis (VL) is a neglected tropical disease, affecting the poor and productive age group of a country, resulting in a huge impact on its economic development. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, there is still death of these patients while on treatment. In this aspect, there are limited studies in Ethiopia; therefore, this study aimed to determine the incidence of mortality and its predictors among adult VL patients at the University of Gondar Hospital. Methods: Institution-based retrospective cohort study was conducted among 586 adult visceral leishmaniasis patients who were admitted to the University of Gondar Hospital from 2013 to 2018. Data were collected from the patients' charts and registration books, and analyzed using Stata 14 software. Kaplan-Meier failure curve and Log rank test was used to compare the survival probability of patients with independent variables. A multivariable stratified Cox regression model was used to identify predictors of mortality among VL patients. P≤ 0.05 was employed to declare statistically significant factors. Adjusted hazard ratio (AHR) and 95% confidence interval (95% CI) were estimated for potential risk factors included in the multivariable model. Results: A total of 586 VL patients were included in the study. The age of patients ranged from 18 to 55 years with a median age of 27 years. The incidence of mortality was 6.6 (95% CI: 5.2-8.4) per 1000 person-days of observation. Independent predictors of mortality were presence of comorbidity (AHR=2.29 (95% CI: 1.27-4.11)), relapse VL (AHR=3.03 (95% CI: 1.25-7.35)), treatment toxicity (AHR=5.87 (95% CI: 3.30-10.44)), nasal bleeding (AHR=2.58 (95% CI: 1.48-4.51)), jaundice (AHR=2.84 (95% CI: 1.57-5.16)) and being bedridden at admission (AHR=3.26 (95% CI: 1.86-5.73)). Conclusion: The incidence of mortality among VL patients was high. Mortality was higher among VL patients with concomitant disease, relapse VL, treatment toxicity, nasal bleeding, jaundice, and those who were bedridden at admission, which implies that great care should be taken for these risky groups through strict follow-up and treatments.

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Parasite load and risk factors for poor outcome among children with visceral leishmaniasis. A cohort study in Belo Horizonte, Brazil, 2010-2011

Cited by 12 publications

References 28 publications

Visceral leishmaniasis treatment outcome and its determinants in northwest Ethiopia

Visceral leishmaniasis treatment outcome and its determinants in northwest Ethiopia

Progress in the Mathematical Modelling of Visceral Leishmaniasis

<p>Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study</p>

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