title: Risk factors, clinical features and outcomes of visceral leishmaniasis in solid-organ transplant recipients: a retrospective multicenter case-control study.
abstract: Visceral leishmaniasis (VL) is a rare disease in solid-organ transplant (SOT) recipients. Therefore, little is known about the risk factors and disease behavior in the transplant setting. This multicenter, matched case-control study (1:2 ratio) was designed to determine the risk factors, clinical features and outcomes of VL among this population. Control and case subjects were matched by center, transplant type and timing. Thirty-six VL cases were identified among 25 139 SOT recipients (0.1%). VL occurred 5.7-fold more frequently in Brazil than in Spain, presenting a median time of 11 months after transplantation. High-dose prednisone in the preceding 6 months was associated with VL. Patients were diagnosed over 1 month after symptom onset in 25% of cases. Thirty-one patients (86%) were febrile upon diagnosis, 81% exhibited visceromegaly and 47% showed pancytopenia. Concomitant infection was common. Parasites were identified in 89% of patients; the remaining patients were diagnosed by serology. The majority of the patients received amphotericin B. Relapses occurred in 25.7% of cases, and the crude mortality rate was 2.8%. VL after SOT is related to the VL prevalence in the general population. Delayed diagnosis frequently occurs. Liposomal amphotericin is the most commonly used therapy; mortality is low, although relapses are common.
authors: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), Belo Horizonte, Minas Gerais, Brazil. Electronic address: wanclemente@yahoo.com.br.
authors: W
authors: W
authors: Clemente
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Disease Unit, Maimonides Institute for Research in Biomedicine of Córdoba (Reina Sofía University Hospital/University of Córdoba), Córdoba, Spain.
authors: E
authors: E
authors: Vidal
authors: Hospital Universitário Walter Cantidio (HUWC) da Universidade Federal do Ceará (HUWC/UFCE), Fortaleza, Ceará, Brazil.
authors: E
authors: E
authors: Girão
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, University Hospital Puerta de Hierro, Madrid, Spain.
authors: A S D
authors: AS
authors: Ramos
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit, University Hospital "12 de Octubre", Madrid, Spain.
authors: F
authors: F
authors: Govedic
authors: Infectious Disease Unit, University General Hospital, Alicante, Spain.
authors: E
authors: E
authors: Merino
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, University General Hospital Gregorio Marañón, Madrid, Spain.
authors: P
authors: P
authors: Muñoz
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, Barcelona, Spain.
authors: N
authors: N
authors: Sabé
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors: C
authors: C
authors: Cervera
authors: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), Belo Horizonte, Minas Gerais, Brazil.
authors: G F
authors: GF
authors: Cota
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, University Hospital Virgen del Rocío, Sevilla, Spain.
authors: E
authors: E
authors: Cordero
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Service, University Hospital Son Espases, Palma de Mallorca, Spain.
authors: A
authors: A
authors: Mena
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit, University Hospital de Cruces, Bilbao, Spain.
authors: M
authors: M
authors: Montejo
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit, University Hospital "12 de Octubre", Madrid, Spain.
authors: F
authors: F
authors: López-Medrano
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit, University Hospital "12 de Octubre", Madrid, Spain.
authors: J M
authors: JM
authors: Aguado
authors: Hospital Universitário Walter Cantidio (HUWC) da Universidade Federal do Ceará (HUWC/UFCE), Fortaleza, Ceará, Brazil.
authors: P
authors: P
authors: Fernandes
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, University General Hospital Gregorio Marañón, Madrid, Spain.
authors: M
authors: M
authors: Valerio
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, Barcelona, Spain.
authors: J
authors: J
authors: Carratalá
authors: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors: A
authors: A
authors: Moreno
authors: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), Belo Horizonte, Minas Gerais, Brazil.
authors: J
authors: J
authors: Oliveira
authors: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), Belo Horizonte, Minas Gerais, Brazil.
authors: P H O
authors: PH
authors: Mourão
authors: Infectious Disease Unit, Maimonides Institute for Research in Biomedicine of Córdoba (Reina Sofía University Hospital/University of Córdoba), Córdoba, Spain.
authors: J
authors: J
authors: Torre-Cisneros
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000981:Antiprotozoal Agents; D011241:Prednisone
keywords: Parasitic infection; posttransplant infection; solid-organ transplant; tropical diseases; visceral leishmaniasis