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[Visceral leishmaniasis in immunocompromised patients]
A Ramos1, J L Portero, T Gazapo
1Servicio de Medicina Interna III, Clínica Puerta de Hierro, Madrid.
Anales De Medicina Interna (Madrid, Spain : 1984)
|July 10, 1998
Summary
Visceral leishmaniasis (VL) in immunocompromised (IC) patients, particularly those with HIV, presents distinct clinical features and prognosis. Lower albumin and globulin levels were associated with mortality in IC patients with VL.
Area of Science:
- Infectious Diseases
- Immunology
- Tropical Medicine
Background:
- Visceral leishmaniasis (VL) disproportionately affects immunocompromised (IC) individuals, notably those co-infected with HIV.
- Understanding clinical variations and prognostic factors in IC patients with VL is crucial for effective management.
Purpose of the Study:
- To compare clinical manifestations, diagnostic test results, and prognosis between HIV-positive (HIV+) and HIV-negative (HIV-) IC patients with VL.
- To identify factors associated with mortality during the initial VL episode in IC patients.
Main Methods:
- A cohort of 16 IC patients with VL was studied, comprising 9 HIV+ and 7 HIV- individuals.
- Clinical data, serological tests for Leishmania, and laboratory markers including CD4+ lymphocyte counts were analyzed.
Main Results:
- HIV+ patients experienced longer symptom duration (70 days) compared to HIV- patients (17 days).
- Mortality during the initial VL episode was 44%, with lower albumin (<3 g/dl) and globulin (<4 g/dl) levels significantly associated with death.
- Lower CD4+ counts in HIV+ patients who died (19/mm³) versus survivors (108/mm³) suggested a poorer prognosis.
Conclusions:
- Clinical presentation and disease course of VL differ between HIV+ and HIV- IC patients.
- Hypoalbuminemia and hypoglobulinemia are significant indicators of mortality in IC patients with VL.
- CD4+ T-cell counts may predict outcomes in HIV-positive individuals with VL.