[Visceral leishmaniasis in immunocompromised patients].
OBJECTIVE
Most patients who developed visceral leishmaniasis (VL) in our country are ímmunocompromised (IC) host, frequently HIV-infected patients. One objective was to know if there were differences about the clinical manifestations, diagnostic tests or prognosis in IC patients who were infected or not with HIV (HIV+ and HIV-, respectively). Also we wonder if some features were associated with death during the initial episodes of VL.


METHODS
We studied 16 IC patients with VL, 9 were VIH+ and 7 were VIH-. Most frequently observed findings were fever (94%), splenomegaly (81%), hepatomegaly (69%), and constitutional syndrome (50%). HIV+ patients had symptoms during a lapse of time (70 +/- 78 days) larger than the VIH- cases had (17 +/- 12 days, p < 0.05).


RESULTS
We performed a serology to Leishmania sp in 15 cases (94%) and were positive in 13 patients (77% in HIV+ and 100% in VIH patients). Seven patients (44%, 4 VIH- and 3 VIH+) died during the initial episode of VL. Nine patients (66%) who survived to it were followed-up during 68 +/- 49 months. Seven patients (4 VIH+ and 3 VIH-) showed several relapses (2.5 +/- 1.6 relapses/patient) through the follow-up. The patients who died during the initial episode had more frequently (p < 0.05) concentrations of albumin below 3 g/dl or of globulins below 4 g/dl, than the survivors had. The CD4+ lymphocyte counts in HIV+ patients were lower in patients who died during the initial episode of VL (19 +/- 15/mm) than in survivors (108 +/- 67/mm3, p = 0.07).
Ramos
A
A
Servicio de Medicina Interna III, Clínica Puerta de Hierro, Madrid.
Portero
J L
JL
Gazapo
T
T
Yebra
M
M
Portero
F
F
Martín
T
T
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D000328:Adult; D005260:Female; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged
Leishmaniasis visceral en pacientes inmunodeprimidos.