Visceral Leishmaniasis in Liver Transplant Recipients From an Endemic Area

Clemente, Wanessa T.; Faria, Luciana Costa; Romanelli, Roberta Maia de Castro; Lima, Stella Sala Soares; Cortes, J.R.G.; Oliveira, Ana; Carvalho, Andréa Lucchesi de; Ferreira, Alexandre Rodrígues; Lima, Agnaldo Soares

doi:10.1097/tp.0b013e31820c4574

Cited by 14 publications

(19 citation statements)

References 16 publications

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“…Overall, only one-third of the patients (n = 12) presented this classic triad when the diagnosis was established. Considering the high frequency of atypical VL in SOT [9,18,[21][22][23][24], disease should not be ruled out even in the absence of typical signs, particularly when the recipient or donor has traveled from an endemic zone.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

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) occurs in <1% of SOT recipients in countries in which the disease is endemic and where transplantation is performed . Slightly more than 100 cases have been published to date, but the actual burden is likely to be higher.…”

Section: Solid Organ Transplant Recipientsmentioning

confidence: 99%

“…Splenic aspiration may, however, be complicated by intra‐abdominal hemorrhage, especially in the presence of thrombocytopenia, and hence should not be used as the first‐line diagnostic test. Liver tissue can also reveal amastigotes in SOT recipients, but biopsy of this organ also carries risk . Amastigotes may also occasionally be detected in peripheral blood .…”

Section: Solid Organ Transplant Recipientsmentioning

confidence: 99%

“…Visceral leishmaniasis (VL) occurs in <1% of SOT recipients in countries in which the disease is endemic and where transplantation is performed. [6][7][8][9][10][11][12] Slightly more than 100 cases have been published to date, but the actual burden is likely to be higher. In a large retrospective analysis of 1754 kidney and liver transplant recipients between 2001 and 2006 in Brazil, a country in which leishmaniasis is endemic, only five (0.3%) cases of VL were identified.…”

Section: Epidemiologymentioning

confidence: 99%

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Leishmaniasis in solid organ and hematopoietic stem cell transplant recipients

Gajurel

Dhakal

Deresinski

2016

Clinical Transplantation

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Leishmaniasis occurs in <1% of solid organ and hematopoietic stem cell transplant recipients in endemic countries in which transplants are performed. Visceral leishmaniasis (VL) makes up the bulk of reported cases. The onset generally occurs months after transplantation and the mode of acquisition is often impossible to determine, but de novo vector-borne infection and reactivation of inapparent infection are thought to be the principal means. The potential role of clinically inapparent donor infection is uncertain and screening is not currently recommended, nor is it recommended for recipients from endemic areas, some of whom may have detectable circulating protozoan nucleic acid. While transplant recipients with VL often present with the non-specific findings of fever and cytopenia, the additional presence of hepatosplenomegaly in patients from endemic areas should lead to a directed diagnostic evaluation with bone marrow examination and PCR testing of marrow and peripheral blood having a high yield. Management may often be complicated by the presence of concomitant infections. A lipid formulation of amphotericin B is the preferred treatment, especially for VL, but the relapse rate in transplant recipients is approximately 25%. PCR monitoring of blood for either secondary prophylaxis or preemptive therapy requires further study.

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Transplant Infections in Developing Countries

Machado

2016

Transplant Infections

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Visceral Leishmaniasis in Liver Transplant Recipients From an Endemic Area

Cited by 14 publications

References 16 publications

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

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

Leishmaniasis in solid organ and hematopoietic stem cell transplant recipients

Transplant Infections in Developing Countries

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