Risk factors for in‐hospital mortality of visceral leishmaniasis patients in eastern Uganda

Abstract

Summaryobjective To identify risk factors for in-hospital mortality in patients treated for visceral leishmaniasis (VL) in Uganda. results Between 2000 and 2005, of 3483 clinically suspect patients, 53% were confirmed with primary VL. Sixty-two per cent were children <16 years of age with a male ⁄ female ratio of 2.2. The overall case-fatality rate during pentavalent antimonial (n = 1641) or conventional amphotericin B treatment (n = 217) was 3.7%. There was no difference in the case-fatality rate between treatment groups (P > 0.20). The main risk factors for in-hospital death identified by a multivariate analysis were age <6 years and >15 years, concomitant tuberculosis or hepatopathy, and drug-related adverse events. The case-fatality rate among patients >45 years of age was strikingly high (29.0%).

Nutritional Status of Adult Kala-azar Patients and Associated Factors in North West, Ethiopia

“…The high magnitude of malnutrition among kala-azar patients was in agreement with the results reported from Nepal (71%), and Uganda (80%), but higher than a study conducted from North Sudan (61.9%) and India (60%) [6,10]. This could be explained by the inadequate infrastructure of the area, which could affect the socio economic status, and health coverage of the residents.…”

Who Is a Typical Patient with Visceral Leishmaniasis? Characterizing the Demographic and Nutritional Profile of Patients in Brazil, East Africa, and South Asia

“…This has been reported previously. 19,20,[22][23][24][25] It is unclear whether this is because of factors such as increased exposure, vulnerability, or health-seeking behavior (it is possible that male patients are more likely to present to health centers for care) and how these factors vary in the different epidemiological and cultural settings. Populations were younger in Latin America than in Africa and South Asia.…”

“…[7][8][9][10][11][12] VL is often associated with malnutrition, which is also a symptom of more severe infection and a major risk factor for poorer clinical and treatment outcomes. [13][14][15][16][17][18][19] The precise mechanisms of the interaction between VL and malnutrition are not well-understood, 19,20 partly because of limited epidemiological data on patient populations. 21 This lack of basic information on VL, particularly demographic and anthropometric data, hinders (1) the ability of health providers to properly prepare for patient management, (2) an informed drug procurement for disease control, and (3) the design of clinical trials and development of new drug therapies in the different endemic areas.…”

Predicting death from kala-azar: construction, development, and validation of a score set and accompanying software

“…Age, disease length, bacterial infections, bleeding, and immunodeficiency seem to be the most important predictors of poor prognosis in studies in Africa (2) (23) (24) (25) and Brazil (6) (26) (27) (28) . Patients with kala-azar at the highest risk of death are those with the clinical symptoms, signs, and laboratory data of more severe disease; early identification of these patients may reduce mortality by enabling referrals to more complex medical attention.…”

“…The risk factors for death in patients with kala-azar by L. infantum have been identifi ed, and prognostic models based on clinical scores have been developed (5) (6) (25) (28) . In a recent meta-analysis, jaundice, thrombocytopenia, hemorrhage, human immunodefi ciency virus-1 (HIV-1) co-infection, diarrhea, age <5 years or >40-50 years, severe neutropenia, dyspnea, and bacterial infections were important risk factors for VL-related death.…”