Visceral leishmaniasis among liver transplant recipients: An overview

Campos‐Varela, Isabel; Len, Óscar; Castells, Lluı́s; Tallada, N; Ribera, Esteban; Dopazo, Cristina; Vargas, Vı́ctor; Gavaldá, Joan; Charco, Ramón

doi:10.1002/lt.21538

Cited by 25 publications

(24 citation statements)

References 19 publications

(25 reference statements)

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“…In addition to liver and kidney, VL has been reported in patients post-transplant for lung, heart, and combined kidney-pancreas [Larocca et al, 2007; Morales et al, 2003; Torregrosa et al, 1993]. Campos-Varela et al [2008] reported on nine cases of VL in liver transplant patients. They found that these VL patients less frequently manifested fever and hepatosplenomegaly, possibly due to iatrogenic immunessupression [Campos-Varela et al, 2008].…”

Section: The Complexity Of Visceral Leishmaniasis In the Presence Of mentioning

confidence: 99%

“…Campos-Varela et al [2008] reported on nine cases of VL in liver transplant patients. They found that these VL patients less frequently manifested fever and hepatosplenomegaly, possibly due to iatrogenic immunessupression [Campos-Varela et al, 2008]. Secondary prophylaxis has been suggested, but there have been no studies to document efficacy of this approach for decreasing recurrence and relapse rates.…”

Section: The Complexity Of Visceral Leishmaniasis In the Presence Of mentioning

confidence: 99%

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New challenges in the epidemiology and treatment of visceral leishmaniasis in periurban areas

Dupnik

Nascimento

Rodrigues-Neto

et al. 2011

Drug Development Research

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Visceral leishmaniasis [VL] represents a major public health problem in many areas of the world. This review focuses on the impact of periurbanization on the epidemiology and treatment of VL, using Brazil as an example. VL continues to be mostly a disease of poverty with impact on families. However, the disease has expanded in Latin America, with foci reported as far south as Argentina. There is an increasing overlap of Leishmania infantum chagasi and HIV infections and other immunosuppressive conditions, resulting in VL emerging as an opportunistic infection. This new setting poses new challenges for VL disease control and patient management.

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Section: The Complexity Of Visceral Leishmaniasis In the Presence Of mentioning

confidence: 99%

Section: The Complexity Of Visceral Leishmaniasis In the Presence Of mentioning

confidence: 99%

New challenges in the epidemiology and treatment of visceral leishmaniasis in periurban areas

Dupnik

Nascimento

Rodrigues-Neto

et al. 2011

Drug Development Research

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“…Although more than 100 VL case reports have been described and reviewed in the literature [1][2][3][4][5], there is a lack of information regarding risk factors, the role of immunosuppression and disease outcome across different types of transplantation. The recognition and management of VL remains challenging even in transplant recipients from endemic regions [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Risk factors, clinical features and outcomes of visceral leishmaniasis in solid-organ transplant recipients: a retrospective multicenter case–control study

Clemente

Vidal

Girão

et al. 2015

Clinical Microbiology and Infection

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Visceral leishmaniasis (VL) is a rare disease in solid-organ transplant (SOT) recipients. Therefore, little is known about the risk factors and disease behavior in the transplant setting. This multicenter, matched case-control study (1:2 ratio) was designed to determine the risk factors, clinical features and outcomes of VL among this population. Control and case subjects were matched by center, transplant type and timing. Thirty-six VL cases were identified among 25 139 SOT recipients (0.1%). VL occurred 5.7-fold more frequently in Brazil than in Spain, presenting a median time of 11 months after transplantation. High-dose prednisone in the preceding 6 months was associated with VL. Patients were diagnosed over 1 month after symptom onset in 25% of cases. Thirty-one patients (86%) were febrile upon diagnosis, 81% exhibited visceromegaly and 47% showed pancytopenia. Concomitant infection was common. Parasites were identified in 89% of patients; the remaining patients were diagnosed by serology. The majority of the patients received amphotericin B. Relapses occurred in 25.7% of cases, and the crude mortality rate was 2.8%. VL after SOT is related to the VL prevalence in the general population. Delayed diagnosis frequently occurs. Liposomal amphotericin is the most commonly used therapy; mortality is low, although relapses are common. Clinical Microbiology and Infection

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“…Unlike Leishmania-HIV coinfection, HIV-unrelated VL has been associated with initial cure rates ranging from 84 [7] to 87% [13], even though antimonials were employed in 65% of patients, and with relapse rates not exceeding 32% [7] or even absent in liver transplant patients treated with LAmB [9]. Unfortunately, existing data are limited to transplant-related VL (represented by kidney transplant in nearly 80% of cases), while controlled studies are not available at the present time.…”

Section: Discussionmentioning

confidence: 97%

“…Death rates may be as high as 22% in transplant-associated VL, although this finding may be partly explained by either delayed or totally missed diagnosis [7] due to a misleading disease presentation. Indeed, in transplant recipients, fever, adenomegalies, and hepatosplenomegaly may be less remarkable-albeit rarely absent-owing to selective T-CD4 cell inhibition, with only marginal effects on the inflammatory response, as well as specific antibody production, with an IFAT sensitivity exceeding 92% [7,9]. A number of VL cases related to anti-tumor necrosis factor (TNF) treatment have also been described recently [10], with the findings consistent with an impairment of intracellular parasite killing.…”

Section: Discussionmentioning

confidence: 99%

Seronegative visceral leishmaniasis with relapsing and fatal course following rituximab treatment

et al. 2011

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Both the presentation and clinical course of visceral leishmaniasis (VL) may be atypical in immunosuppressed subjects, often resulting in delayed diagnosis and treatment. We describe a case of VL characterized by negative serologic testing, a relapsing course, and a fatal outcome 2 years after the patient had been successfully treated for non-Hodgkin's lymphoma with rituximab. Diagnosis of VL may be further delayed or even missed in patients treated with drugs that interfere with specific antibody production unless specific diagnostic methods, such as bone marrow examination and parasite DNA amplification/detection, are routinely employed.

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Visceral leishmaniasis among liver transplant recipients: An overview

Cited by 25 publications

References 19 publications

New challenges in the epidemiology and treatment of visceral leishmaniasis in periurban areas

New challenges in the epidemiology and treatment of visceral leishmaniasis in periurban areas

Risk factors, clinical features and outcomes of visceral leishmaniasis in solid-organ transplant recipients: a retrospective multicenter case–control study

Seronegative visceral leishmaniasis with relapsing and fatal course following rituximab treatment

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