title: Mediterranean visceral leishmaniasis in HIV-negative adults: a retrospective analysis of 64 consecutive cases (1995-2001).
abstract: OBJECTIVE
  To evaluate in a retrospective analysis cases of Mediterranean visceral leishmaniasis (VL) diagnosed in HIV-negative adults during a 7-year period.
  
  
  METHODS
  Demographic data, previous or underlying diseases, clinical and laboratory features and therapeutic findings were considered.
  
  
  RESULTS
  A total of 64 patients were included, of whom 10 (16%) had underlying diseases and two were pregnant. Fever and hepatosplenomegaly were the main presenting symptoms, whereas pancytopenia and an elevated erythrocyte sedimentation rate were observed in all cases. Smears from bone marrow aspirate were positive at microscopy in 62 cases (97%). Twenty-four patients received meglumine antimoniate (MA) given during 21 consecutive days (20 mg/kg per day), and 40 patients liposomal amphotericin B (l-AmB) given at days 1-5 and 10 (3 mg/kg per day). Both groups' clinical and laboratory findings improved, but patients on l-AmB therapy had a faster recovery (85% on l-AmB therapy and 50% on MA therapy showed defervescence at day 5, P < 0.01). Treatment failures were observed in five cases, three (12%) on MA and two (5%) on l-AmB therapy. No significant toxicity was observed in patients treated with l-AmB, whereas three (12%) patients treated with MA showed electrocardiographic abnormalities.
  
  
  CONCLUSIONS
  l-AmB therapy may be considered the treatment of choice for any adult patients with Mediterranean VL, since it permits a faster recovery, has a lower incidence of side effects and is useful also in immunosuppressed patients.
authors.affiliation: I Division of Infectious Disease, D. Cotugno Hospital, Naples, Italy. ppagliano@libero.it
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pagliano
authors.forename: Marco
authors.initials: M
authors.lastname: Rossi
authors.forename: Carolina
authors.initials: C
authors.lastname: Rescigno
authors.forename: Sergio
authors.initials: S
authors.lastname: Altieri
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Coppola
authors.forename: Marina
authors.initials: M
authors.lastname: Gramiccia
authors.forename: Aldo
authors.initials: A
authors.lastname: Scalone
authors.forename: Luigi
authors.initials: L
authors.lastname: Gradoni
authors.forename: Francesco
authors.initials: F
authors.lastname: Faella
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D010713:Phosphatidylcholines / Q000627:therapeutic use*; D010715:Phosphatidylglycerols / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D004338:Drug Combinations; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D000666:Amphotericin B