Visceral leishmaniasis in patients infected with the human immunodeficiency virus.
The experience with 52 episodes of visceral leishmaniasis diagnosed in 43 patients is reported. The most common symptoms were fever (81%), splenomegaly (65%), hepatomegaly (63%), and pancytopenia (73%). In 79% of the patients, CD4+ cell counts were < 100 cells/mm3. Prior or simultaneous diagnosis of AIDS was made in 29 (67%) patients. Diagnosis was considered fortuitous in 19% of the episodes. In 27% of the episodes, the diagnosis was made on the basis of demonstration of parasites outside the reticuloendothelial system, chiefly blood (7 cases) and gastrointestinal mucosa (5 cases). Parasites were frequently observed or cultured from blood (22/37 episodes) or the digestive tract (8/9 episodes). High antimony doses were more effective than low doses in achieving clinical or parasitological cure (rate of cure, 80% vs. 40%, p = 0.11). Severe toxicity was observed in six (11.7%) of the 51 treated episodes. Severe AIDS-related diseases [odds ratio (OR) 10, p < 0.05] and CD4+ counts (OR 12, p < 0.05) were independent factors for early death. Prophylaxis with monthly pentamidine was not useful in reducing relapses of visceral leishmaniasis.
Laguna
F
F
Servicio de Enfermedades Infecciosas, Centro Nacional de Investigación Clínica, Instituto de Salud Carlos III, Madrid, Spain.
Adrados
M
M
Alvar
J
J
Soriano
V
V
Valencia
M E
ME
Moreno
V
V
Polo
R
R
Verdejo
J
J
Jiménez
M I
MI
Martínez
P
P
Martínez
M L
ML
González-Lahoz
J M
JM
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology; D000493:Allopurinol / Q000627:therapeutic use; D000563:Amebicides / Q000627:therapeutic use; D000666:Amphotericin B / Q000627:therapeutic use; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000963:Antimetabolites / Q000627:therapeutic use; D000965:Antimony / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001769:Blood / Q000469:parasitology; D001853:Bone Marrow / Q000469:parasitology; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000187:drug effects; D002555:Cerebrospinal Fluid / Q000469:parasitology; D016049:Didanosine / Q000627:therapeutic use; D004064:Digestive System / Q000469:parasitology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006678:HIV; D006501:Hepatic Encephalopathy / Q000139:chemically induced; D006801:Humans; D007413:Intestinal Mucosa / Q000469:parasitology; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology; D018655:Lymphocyte Count / Q000187:drug effects; D008297:Male; D009205:Myocarditis / Q000139:chemically induced; D009504:Neutrophils / Q000469:parasitology; D010195:Pancreatitis / Q000139:chemically induced; D010419:Pentamidine / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000139:chemically induced; D013030:Spain / Q000453:epidemiology; D015215:Zidovudine / Q000627:therapeutic use
D000563:Amebicides; D019380:Anti-HIV Agents; D000963:Antimetabolites; D000981:Antiprotozoal Agents; D015215:Zidovudine; D000493:Allopurinol; D010419:Pentamidine; D000666:Amphotericin B; D000965:Antimony; D016049:Didanosine