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Artigo Acesso aberto Produção Nacional Revisado por pares
BIBTEX RIS

Risk factors, clinical features and outcomes of visceral leishmaniasis in solid-organ transplant recipients: a retrospective multicenter case–control study

2014; Elsevier BV; Volume: 21; Issue: 1 Linguagem: Inglês

10.1016/j.cmi.2014.09.002

ISSN

1469-0691

Autores

W.T. Clemente, E. Vidal, Evelyne Santana Girão, A.S.D. Ramos, F. Govedic, Esperanza Merino, Patricia Muñóz, Núria Sabé, Carlos Cervera, Gláucia Cota, Elisa Cordero, Álvaro Mena, Miguel Montejo, Francisco López‐Medrano, José María Aguado, Paula Frassinetti Castelo Branco Camurça Fernandes, Maricela Valerio, Jordi Carratalà, Asunción Moreno, João Antônio de Queiroz Oliveira, Paulo Henrique Orlandi Mourão, Julián Torre-Cisneros,

Tópico(s)

Parasites and Host Interactions

Resumo

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.

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