title: Epidemiologic surveillance of visceral leishmaniasis in Sicily, Italy.
abstract: Visceral leishmaniasis (VL) is endemic in Sicily. Although it is a notifiable disease, there is evidence that the actual number of cases is higher than that reported. In 1987, a regional reference center for active surveillance of VL was established and it recorded a total of 284 cases through 1995, a mean of 31.5 cases/year and about four-fold more than previously reported. Of the 284 cases, 150 (53%) were children (< or = 14 years of age), and of the 134 adults, 39 (29%) were coinfected with human immunodeficiency virus (HIV). The commonest viscerotropic zymodeme of Leishmania infantum, MON 1, was identified in 40 (93%) of 43 HIV-negative and eight (57%) of 14 HIV-positive patients. Among 280 patients evaluated (i.e., all HIV-negative and 35 of 39 HIV-positive subjects), 254 (91%) were treated with meglumine antimoniate alone or in combination with other drugs; 23 (8%) received allopurinol or amphotericin B, either conventional or in liposomal form; and three terminally ill patients were not treated. Among the 245 HIV-negative patients, 236 (96%) were successfully cured, while nine (4%) (seven adults) died during the course of antimonial treatment. None of the 35 HIV-positive patients was definitively cured, although mortality was apparently associated with other opportunistic infections.
authors.affiliation: Istituto di Patologia Infettiva e Virologia, Università di Palermo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cascio
authors.forename: L
authors.initials: L
authors.lastname: Gradoni
authors.forename: F
authors.initials: F
authors.lastname: Scarlata
authors.forename: M
authors.initials: M
authors.lastname: Gramiccia
authors.forename: S
authors.initials: S
authors.lastname: Giordano
authors.forename: R
authors.initials: R
authors.lastname: Russo
authors.forename: A
authors.initials: A
authors.lastname: Scalone
authors.forename: C
authors.initials: C
authors.lastname: Camma
authors.forename: L
authors.initials: L
authors.lastname: Titone
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use; D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007223:Infant; D018314:Leishmania infantum / Q000302:isolation & purification*; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008536:Meglumine / Q000008:administration & dosage / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D017678:Sex Distribution; D012802:Sicily / Q000453:epidemiology
chemical_list: D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D000493:Allopurinol; D008536:Meglumine; D000077485:Meglumine Antimoniate; D000666:Amphotericin B