The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases 2018 03 27() pii 10.1016/j.bjid.2018.03.001
Visceral Leishmaniasis (VL) is the most severe form of disease caused by the Leishmania donovani complex, with significant morbidity and mortality in developing countries. Worse outcomes occur among HIV-positive individuals coinfected with Leishmania. It is unclear, however, if there are significant differences on presentation between VL patients with or without HIV coinfection.
We reviewed medical records from adult patients with VL treated at a reference healthcare center in Fortaleza – Ceará, Brazil, from July 2010 to December 2013. Data from HIV-coinfected patients have been abstracted and compared to non-HIV controls diagnosed with VL in the same period.
Eighty one HIV-infected patients and 365 controls were enrolled. The diagnosis in HIV patients took significantly longer, with higher recurrence and death rates. Kala-azar’s classical triad (fever, constitutional symptoms and splenomegaly) was less frequently observed in VL-HIV patients, as well as jaundice and edema, while diarrhea was more frequent. Laboratory features included lower levels of hemoglobin, lymphocyte counts and liver enzymes, as well as higher counts of blood platelets and eosinophils. HIV-infected patients were diagnosed mainly through amastigote detection on bone marrow aspirates and treated more often with amphotericin B formulations, whereas in controls, rK39 was the main diagnostic tool and pentavalent antimony was primarily used for treatment.
Clinical and laboratory presentation of VL in HIV-coinfected patients may differ from classic kala-azar, and these differences may be, in part, responsible for the delay in diagnosing and treating VL, which might lead to worse outcomes.