Varied spectrum of clinical presentation and mortality in a prospective registry of visceral leishmaniasis in a low endemicity area of Northern Italy

Giovanni Cenderello, Ambra Pasa, Andrea Dusi, Chiara Dentone, Federica Toscanini, Nicoletta Bobbio, Elisabetta Bondi, Valerio Del Bono, Manuela Izzo, Giovanni Riccio, Marco Anselmo, Raffaella Giacchino, Maria Grazia Marazzi, Gabriella Pagano, Giovanni Cassola, Claudio Viscoli, Giuseppe Ferrea, Andrea De Maria

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Abstract

Background: Visceral Leishmaniasis (VL) is endemic in 88 countries, in areas of relatively low incidence with a relevant proportion of immune suppressed patients clinical presentation, diagnosis and management may present difficulties and pitfalls.Methods: Demographic data, clinical, laboratory features and therapeutic findings were recorded in patients identified by a regional VL disease registry from January 2007 to December 2010.Results: A total of 55 patients (36 adults mean age 48.7 years, 19 children median age 37.5 months) were observed presenting with 65 episodes. All childen were immunocompetent, whereas adults affected by VL included both immunocompetent (n°17) and immunesuppressed (n°19) patients. The clinical presentation was homogeneous in children with predominance of fever and hepato-splenomegaly. A wider spectrum of clinical presentations was observed in immunocompromised adults. Bone marrow detection of intracellular parasites (Giemsa staining) and serology (IFAT) were the most frequently used diagnostic tools. In addition, detection of urinary antigen was used in adult patients with good specificity (90%). Liposomal amphotericin B was the most frequently prescribed first line drug (98.2% of cases) with 100% clinical cure. VL relapses (n°10) represented a crucial finding: they occurred only in adult patients, mainly in immunocompromised patients (40% of HIV, 22% of non-HIV immunocompromised patients, 5,9% of immunocompetent patients). Furthermore, three deaths with VL were reported, all occurring in relapsing immunocompromised patients accounting for a still high overall mortality in this group (15.8%).Conclusions: The wide spectrum of clinical presentation in immunesuppresed patients and high recurrence rates still represent a clinical challenge accounting for high mortality. Early clinical identification and satisfactory treatment performance with liposomal amphotericin B are confirmed in areas with low-level endemicity and good clinical standards. VL needs continuing attention in endemic areas where increasing numbers of immunocompromised patients at risk are dwelling.

Original languageEnglish
Article number248
JournalBMC Infectious Diseases
Volume13
Issue number1
DOIs
Publication statusPublished - May 30 2013

Keywords

  • HIV
  • Immunocompromised host
  • Visceral leishmaniasis

ASJC Scopus subject areas

  • Infectious Diseases

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    Cenderello, G., Pasa, A., Dusi, A., Dentone, C., Toscanini, F., Bobbio, N., Bondi, E., Del Bono, V., Izzo, M., Riccio, G., Anselmo, M., Giacchino, R., Marazzi, M. G., Pagano, G., Cassola, G., Viscoli, C., Ferrea, G., & De Maria, A. (2013). Varied spectrum of clinical presentation and mortality in a prospective registry of visceral leishmaniasis in a low endemicity area of Northern Italy. BMC Infectious Diseases, 13(1), [248]. https://doi.org/10.1186/1471-2334-13-248