title: High visceral leishmaniasis mortality rate in Barra Mansa, a new area of visceral leishmaniasis transmission in the State of Rio de Janeiro, Brazil.
abstract: BACKGROUND
  Nine cases of visceral leishmaniasis occurred recently in Barra Mansa, State of Rio de Janeiro, with a high mortality rate.
  
  
  METHODS
  We reviewed the medical records of the patients.
  
  
  RESULTS
  Eight were male; 7 were adults. Patients who died progressed to death quickly and presented with aggravating factors: systemic steroid therapy before diagnosis, bleeding, severe liver involvement, infection, and/or refusal to receive transfusion.
  
  
  CONCLUSIONS
  We warn clinicians to be aware of the emergence of visceral leishmaniasis in new areas and to keep in mind the possibility of atypical clinical pictures and aggravating factors, so timely diagnosis can be made and prompt and adequate treatment can be initiated.
authors.affiliation: Laboratório de Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors.forename: Maria Inês Fernandes
authors.initials: MI
authors.lastname: Pimentel
authors.affiliation: Coordenação de Vigilância Epidemiológica, Secretaria Municipal de Saúde de Barra Mansa, Barra Mansa, RJ, Brasil.
authors.forename: Elisabeth Larcher Maximiano
authors.initials: EL
authors.lastname: Alves
authors.affiliation: Santa Casa de Misericórdia de Barra Mansa, Barra Mansa, RJ, Brasil.
authors.forename: Maria Hercília Fiuza Farias da
authors.initials: MH
authors.lastname: Silva
authors.affiliation: Gerência de Doenças Transmitidas por Vetores e Zoonoses, Secretaria de Estado de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Patrícia Gazenmüller
authors.initials: PG
authors.lastname: Moza
authors.affiliation: Gerência de Doenças Transmitidas por Vetores e Zoonoses, Secretaria de Estado de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Paula Maria Pereira de
authors.initials: PM
authors.lastname: Almeida
authors.affiliation: Coordenação de Vigilância Epidemiológica, Secretaria Municipal de Saúde de Barra Mansa, Barra Mansa, RJ, Brasil.
authors.forename: Cristiane Silveira
authors.initials: CS
authors.lastname: Cunha
authors.affiliation: Laboratório de Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors.forename: Cíntia Xavier de
authors.initials: CX
authors.lastname: Mello
authors.affiliation: Laboratório de Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors.forename: Armando de Oliveira
authors.initials: Ade O
authors.lastname: Schubach
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult