title: Varied spectrum of clinical presentation and mortality in a prospective registry of visceral leishmaniasis in a low endemicity area of Northern Italy.
abstract: BACKGROUND
  Visceral Leishmaniasis (VL) is endemic in 88 countries, in areas of relatively low incidence with a relevant proportion of immune suppressed patients clinical presentation, diagnosis and management may present difficulties and pitfalls.
  
  
  METHODS
  Demographic data, clinical, laboratory features and therapeutic findings were recorded in patients identified by a regional VL disease registry from January 2007 to December 2010.
  
  
  RESULTS
  A total of 55 patients (36 adults mean age 48.7 years, 19 children median age 37.5 months) were observed presenting with 65 episodes. All childen were immunocompetent, whereas adults affected by VL included both immunocompetent (n°17) and immunesuppressed (n°19) patients. The clinical presentation was homogeneous in children with predominance of fever and hepato-splenomegaly. A wider spectrum of clinical presentations was observed in immunocompromised adults. Bone marrow detection of intracellular parasites (Giemsa staining) and serology (IFAT) were the most frequently used diagnostic tools. In addition, detection of urinary antigen was used in adult patients with good specificity (90%). Liposomal amphotericin B was the most frequently prescribed first line drug (98.2% of cases) with 100% clinical cure. VL relapses (n°10) represented a crucial finding: they occurred only in adult patients, mainly in immunocompromised patients (40% of HIV, 22% of non-HIV immunocompromised patients, 5,9% of immunocompetent patients). Furthermore, three deaths with VL were reported, all occurring in relapsing immunocompromised patients accounting for a still high overall mortality in this group (15.8%).
  
  
  CONCLUSIONS
  The wide spectrum of clinical presentation in immunesuppresed patients and high recurrence rates still represent a clinical challenge accounting for high mortality. Early clinical identification and satisfactory treatment performance with liposomal amphotericin B are confirmed in areas with low-level endemicity and good clinical standards. VL needs continuing attention in endemic areas where increasing numbers of immunocompromised patients at risk are dwelling.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cenderello
authors.forename: Ambra
authors.initials: A
authors.lastname: Pasa
authors.forename: Andrea
authors.initials: A
authors.lastname: Dusi
authors.forename: Chiara
authors.initials: C
authors.lastname: Dentone
authors.forename: Federica
authors.initials: F
authors.lastname: Toscanini
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Bobbio
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bondi
authors.forename: Valerio
authors.initials: V
authors.lastname: Del Bono
authors.forename: Manuela
authors.initials: M
authors.lastname: Izzo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Riccio
authors.forename: Marco
authors.initials: M
authors.lastname: Anselmo
authors.forename: Raffaella
authors.initials: R
authors.lastname: Giacchino
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Marazzi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pagano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cassola
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrea
authors.forename: Andrea
authors.initials: A
authors.lastname: De Maria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B