[Visceral leishmaniasis in immunocompromised patients]

Most patients who developed visceral leishmaniasis (VL) in our country are ímmunocompromised (IC) host, frequently HIV-infected patients. One objective was to know if there were differences about the clinical manifestations, diagnostic tests or prognosis in IC patients who were infected or not with HIV (HIV+ and HIV-, respectively). Also we wonder if some features were associated with death during the initial episodes of VL.

We studied 16 IC patients with VL, 9 were VIH+ and 7 were VIH-. Most frequently observed findings were fever (94%), splenomegaly (81%), hepatomegaly (69%), and constitutional syndrome (50%). HIV+ patients had symptoms during a lapse of time (70 +/- 78 days) larger than the VIH- cases had (17 +/- 12 days, p < 0.05).

We performed a serology to Leishmania sp in 15 cases (94%) and were positive in 13 patients (77% in HIV+ and 100% in VIH patients). Seven patients (44%, 4 VIH- and 3 VIH+) died during the initial episode of VL. Nine patients (66%) who survived to it were followed-up during 68 +/- 49 months. Seven patients (4 VIH+ and 3 VIH-) showed several relapses (2.5 +/- 1.6 relapses/patient) through the follow-up. The patients who died during the initial episode had more frequently (p < 0.05) concentrations of albumin below 3 g/dl or of globulins below 4 g/dl, than the survivors had. The CD4+ lymphocyte counts in HIV+ patients were lower in patients who died during the initial episode of VL (19 +/- 15/mm) than in survivors (108 +/- 67/mm3, p = 0.07).