Risk Factors for Death from Visceral Leishmaniasis in an Urban Area of Brazil

<div><p>Background</p><p>Over the last three decades, the epidemiological profile of visceral leishmaniasis (VL) has changed with epidemics occurring in large urban centers of Brazil, an increase in HIV/AIDS co-infection, and a significant increase in mortality. The objective of this study was to identify the risk factors associated with death among adult patients with VL from an urban endemic area of Brazil.</p><p>Methodology</p><p>A prospective cohort study included 134 adult patients with VL admitted to the University Hospital of the Federal University of Mato Grosso do Sul between August 2011 and August 2013.</p><p>Principal Findings</p><p>Patients ranged from 18 to 93 years old, with a mean age of 43.6 (±15.7%). Of these patients, 36.6% were co-infected with HIV/AIDS, and the mortality rate was 21.6%. In a multivariate analysis, the risk factors associated with death were secondary bacterial infection (42.86, 5.05–363.85), relapse (12.17, 2.06–71.99), edema (7.74, 1.33–45.05) and HIV/AIDS co-infection (7.33, 1.22–43.98).</p><p>Conclusions/Significance</p><p>VL has a high mortality rate in adults from endemic urban areas, especially when coinciding with high rates of HIV/AIDS co-infection.</p></div

Adult survival, positive for visceral leishmaniasis, stratified by the presence (n = 49) or absence (n = 105) of HIV/AIDS infection during a 12-month follow-up period.

<p>Log-rank test = 11, 2534; p = 0,0008.</p

Adult patients with visceral leishmaniasis according to the following aspects: demographic; clinical; therapeutic; co-morbidities and evolution to death (n = 134).

<p>The results are presented as relative frequency (absolute frequency). RR = relative risk. CI 95% = Confidence interval of 95%. P values in the chi-square test. Significant risks are indicated by <i>p</i> values in bold.</p><p>Adult patients with visceral leishmaniasis according to the following aspects: demographic; clinical; therapeutic; co-morbidities and evolution to death (n = 134).</p

Univariate and multivariate analysis and progress to death in adult patients with visceral leishmaniasis (n = 134).

<p>RR = relative risk. CI 95% = Confidence interval of 95%.</p><p>Multivariate analysis was followed by the Wald test and correlation matrix.</p><p>Univariate and multivariate analysis and progress to death in adult patients with visceral leishmaniasis (n = 134).</p