Current clinical, laboratory, and treatment outcome characteristics of visceral leishmaniasis: results from a seven-year retrospective study in Greece.
OBJECTIVE
Visceral leishmaniasis (VL) is re-emerging in endemic areas. The epidemiological, clinical, laboratory, and treatment outcome characteristics in a large cohort of VL patients is described herein.


METHODS
The cases of 67 VL patients (57% male, mean age 56 years) treated in two Greek hospitals over the last 7 years were identified and evaluated retrospectively.


RESULTS
Forty-six percent of patients reported contact with animals. Seventeen patients (25%) were immunocompromised, and 22% were co-infected with another pathogen. Sixty-four percent of patients had fever, 57% had weakness, 37% had sweats, 21% had weight loss, and 13% had a dry cough, while 6% developed haemophagocytic syndrome. The median duration of symptoms was 28 days. Fifty-eight percent of patients had splenomegaly, 49% had hepatomegaly, and 36% had lymphadenopathy. The diagnosis was established by positive PCR in peripheral blood (73%) and/or bone marrow specimens (34%). Sixty-one patients (91%) received liposomal amphotericin (L-AMB). Six patients (10%) did not respond or relapsed but were eventually cured after a second cycle of L-AMB. During a 6-month follow-up, the overall mortality was 9%, although none of these deaths was attributed to VL.


CONCLUSIONS
VL is still a common disease in endemic areas, affecting immunocompetent and immunocompromised patients. Its diagnosis is challenging, and molecular techniques are valuable and helpful tools to achieve this. Treatment with L-AMB is safe and very effective.
Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Biopolis, 41110, Larissa, Greece.
Sarah P
SP
Georgiadou
Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Biopolis, 41110, Larissa, Greece.
Aggelos
A
Stefos
Department of Parasitology, Entomology and Tropical Diseases, National School of Public Health, Athens, Greece.
Gregory
G
Spanakos
Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Biopolis, 41110, Larissa, Greece.
Stergios
S
Skrimpas
Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Biopolis, 41110, Larissa, Greece.
Konstantinos
K
Makaritsis
Department of Pathophysiology, Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Nikolaos V
NV
Sipsas
Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Biopolis, 41110, Larissa, Greece. Electronic address: georgedalekos@gmail.com.
George N
GN
Dalekos
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001853:Bone Marrow; D060085:Coinfection / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D021821:Communicable Diseases, Emerging / Q000175:diagnosis* / Q000178:diet therapy* / Q000453:epidemiology*; D005260:Female; D005334:Fever / Q000188:drug therapy; D006115:Greece / Q000453:epidemiology; D006529:Hepatomegaly / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D016867:Immunocompromised Host; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D051359:Lymphohistiocytosis, Hemophagocytic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013163:Splenomegaly / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B
Haemophagocytic syndrome; Liposomal amphotericin; PCR; Parasite; Visceral leishmaniasis