title: Comparative analysis of pediatric and adult visceral leishmaniasis in Brazil.
abstract: BACKGROUND
  The aim of this study was to compare clinical manifestations, laboratory data, morbidity and mortality between adults and children with visceral leishmaniasis, with a focus on kidney function.
  
  
  METHODS
  This was a retrospective cohort study with 432 patients with visceral leishmaniasis diagnosed at 1 center in the northeast of Brazil. Patients were divided into 2 groups according to age (>21 years and ≤ 21 years old).
  
  
  RESULTS
  The time between onset of symptoms and beginning of treatment was longer in adults (89.5 versus 48.5 days, P < 0.001); signs and symptoms were similar in both groups. Failure of treatment with glucantime was more common in adults (17.6% versus 8.8%, P = 0.008). Acute kidney injury was observed in 160 patients (37.0%), and it was more severe in adults. Risk factors for acute kidney injury in adults were hypokalemia, leukopenia, chills and amphotericin B use. In children, secondary infections were found to increase the risk for acute kidney injury. Overall mortality was 8.8%, and it was significantly higher in adults (12.6% versus 4.1%, P = 0.002).
  
  
  CONCLUSIONS
  The adult population had more severe laboratory abnormalities and a worse prognosis, possibly due to delay in diagnosis. Acute kidney injury is prevalent in both groups, and it is usually more severe in adults.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, School of Medicine, Federal University of Ceará, Ceará, Brazil.
authors.forename: Natália A
authors.initials: NA
authors.lastname: Rocha
authors.forename: Michelle J C
authors.initials: MJ
authors.lastname: Oliveira
authors.forename: Luiz F L G
authors.initials: LF
authors.lastname: Franco
authors.forename: Geraldo B Silva
authors.initials: GB
authors.lastname: Júnior
authors.forename: Marília P
authors.initials: MP
authors.lastname: Alves
authors.forename: Aline M
authors.initials: AM
authors.lastname: Sampaio
authors.forename: Bárbara R L
authors.initials: BR
authors.lastname: Montenegro
authors.forename: Ana Patrícia F
authors.initials: AP
authors.lastname: Vieira
authors.forename: Camilla N
authors.initials: CN
authors.lastname: Jacinto
authors.forename: Krasnalhia Lívia S
authors.initials: KL
authors.lastname: Abreu
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Daher
mesh_terms: D058186:Acute Kidney Injury / Q000469:parasitology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D008536:Meglumine; D000077485:Meglumine Antimoniate