title: Visceral leishmaniasis-hepatitis B/C coinfections: a rising necessity to triage patients for treatment.
abstract: OBJECTIVE
  Visceral leishmaniasis (VL) is a life-threatening infection caused by Leishmania species. In Sudan, VL is caused by L donovani. Most drugs used to treat VL, especially pentavalent antimony compounds (sodium stibogluconate, SSG), are potentially hepatotoxic. A number of fatal catastrophes happened because patients with VL-hepatitis B/C coinfection were indiscriminately treated with SSG in settings where VL and viral hepatitis coexist. This study aimed to study biochemical and hematological parameters of patients with VL-hepatitis B/C coinfections with the aim to modify treatment protocols to reduce coinfection.added morbidity and mortality.
  
  
  METHODS
  This was a prospective analytical, hospital-based, and case-controlled study. The study was done at Kassab Hospital and Professor Elhassan Centre for tropical medicine during the period of February 2008 to April 2013.
  
  
  METHODS
  Following informed consent by the participants, 78 parasitologically confirmed VL patients with either hepatitis B or C or both and 528 sex- and age-unmatched VL patients without hepatitis B/C coinfection (control group) were enrolled sequentially. Diagnosis of hepatitis B or C was made using immunochromatographic test kits and confirmed by an enzyme-linked immunosorbent assay.
  
  
  RESULTS
  VL patients with hepatitis B/C coinfections had significantly increased levels of AST, ALT, and total bilirubin compared to the control group (P=.0001 for all), with significantly decreased levels of albumin and platelets counts (P=.0029 for both).
  
  
  CONCLUSIONS
  VL-hepatitis B/C coinfections are an emerging entity that needs anti-leishmanial treatment modification. Alternative treatments like paromomycin and amphotericin B (AmBisome) could be reserved for these patients.
authors.forename: Abubakr O
authors.initials: AO
authors.lastname: A
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: M
authors.forename: Hatim A
authors.initials: HA
authors.lastname: A
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Elamin
authors.forename: Brima M
authors.initials: BM
authors.lastname: Younis
authors.forename: Mona E
authors.initials: ME
authors.lastname: E
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Musa
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elhassan
authors.forename: Eltahir A
authors.initials: EA
authors.lastname: G
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000418:Albumins / Q000032:analysis; D000981:Antiprotozoal Agents / Q000009:adverse effects; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D060085:Coinfection / Q000097:blood* / Q000201:enzymology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006509:Hepatitis B / Q000097:blood* / Q000150:complications / Q000201:enzymology; D006526:Hepatitis C / Q000097:blood* / Q000150:complications / Q000201:enzymology; D006761:Hospitals; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000201:enzymology; D008297:Male; D010976:Platelet Count; D011446:Prospective Studies; D016896:Treatment Outcome; D014218:Triage; D055815:Young Adult
chemical_list: D000418:Albumins; D000981:Antiprotozoal Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin