Leishmania-HIV Co-infection: Clinical Presentation and Outcomes in an Urban Area in Brazil

Submitted by Nuzia Santos ([email protected]) on 2015-02-19T15:24:11Z No. of bitstreams: 1 2014_085.pdf: 219256 bytes, checksum: a2c692be2c14cd0540105f2b7d277261 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-02-19T15:24:19Z (GMT) No. of bitstreams: 1 2014_085.pdf: 219256 bytes, checksum: a2c692be2c14cd0540105f2b7d277261 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-02-19T15:28:58Z (GMT) No. of bitstreams: 1 2014_085.pdf: 219256 bytes, checksum: a2c692be2c14cd0540105f2b7d277261 (MD5)Made available in DSpace on 2015-02-19T15:28:58Z (GMT). No. of bitstreams: 1 2014_085.pdf: 219256 bytes, checksum: a2c692be2c14cd0540105f2b7d277261 (MD5) Previous issue date: 2014Fundaçao Oswaldo Cruz. Centro de Pesquisas Rene Rachou. Laboratório de Pesquisas Clinicas. Belo Horizonte, MG, Brasil / Fundação Hospitalar do Estado de Minas Gerais. Hospital Eduardo de Menezes. Belo Horizonte, MG, Brasil.Universidade Federal de Minas Gerais. Programa de Pós Graduação em Ciências da Saúde. Belo Horizonte, Minas Gerais, Brasil.Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil.Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil.Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil.Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas Rene Rachou. Laboratório de Pesquisas Clinicas. Belo Horizonte, MG, Brasil.BACKGROUND: Visceral leishmaniasis (VL) is an emerging condition affecting HIV-infected patients living in Latin America, particularly in Brazil. Leishmania-HIV coinfection represents a challenging diagnosis because the clinical picture of VL is similar to that of other disseminated opportunistic diseases. Additionally, coinfection is related to treatment failure, relapse and high mortality. OBJECTIVE: To assess the clinical-laboratory profile and outcomes of VL-HIV-coinfected patients using a group of non HIV-infected patients diagnosed with VL during the same period as a comparator. METHODS: The study was conducted at a reference center for infectious diseases in Brazil. All patients with suspected VL were evaluated in an ongoing cohort study. Confirmed cases were divided into two groups: with and without HIV coinfection. Patients were treated according to the current guidelines of the Ministry of Health of Brazil, which considers antimony as the first-choice therapy for non HIV-infected patients and recommends amphotericin B for HIV-infected patients. After treatment, all patients with CD4 counts below 350 cells/mm3 received secondary prophylaxis with amphotericin B. RESULTS: Between 2011 and 2013, 168 patients with suspected VL were evaluated, of whom 90 were confirmed to have VL. In total, 51% were HIV coinfected patients (46 patients). HIV-infected patients had a lower rate of fever and splenomegaly compared with immunocompetent patients. The VL relapse rate in 6 months was 37% among HIV-infected patients, despite receiving secondary prophylaxis. The overall case-fatality rate was 6.6% (4 deaths in the HIV-infected group versus 2 deaths in the non HIV-infected group). The main risk factors for a poor outcome at 6 months after the end of treatment were HIV infection, bleeding and a previous VL episode. CONCLUSION: Although VL mortality rates among HIV-infected individuals are close to those observed among immunocompetent patients treated with amphotericin B, HIV coinfection is related to a low clinical response and high relapse rates within 6 months

Demographic and clinical variables according to HIV infection status.

<p><b>SD</b>: standard deviation <b>IR</b>: 25–75% interquartile range <b>VL</b>: visceral leishmaniasis.</p>#<p>measured on physical examination at the left midclavicular line.</p>§<p>measured on physical examination at the right midclavicular line.</p><p><b>Hepatosplenomegaly</b>: palpable spleen or liver 2 cm over the right costal margin, as measured on physical examination <b>Cytopenia</b>: the presence of hemoglobin below 12 g% or a leukocyte count of less than 3500 cells/mm³ or a platelet count of less than 120000 cells/mm³<b>GOT:</b> glutamate oxaloacetate transaminases</p

Factors associated with early death (within 1 month after VL diagnosis) from visceral leishmaniasis (univariate analysis).

<p><b>Severe neutropenia: a</b> neutrophil count of less than 500 cells/mm³<b>Severe thrombocytopenia: a</b> platelet count of less than 50000 cells/mm³.</p

Variables that remained in the final logistic regression model and were associated with a poor outcome in VL (at 6 months after VL diagnosis).

<p>Hosmer-Lemeshow goodness-of-fit test. p = 0.24.</p

Treatment and outcomes according to HIV infection status.

<p><b>VL</b>: visceral leishmaniasis <b>Fever response</b>: the disappearance of fever at the end of treatment <b>Hemoglobin response</b>: patients presenting an increase of 2 g% or more in hemoglobin tax at the end of treatment <b>Leukocyte response</b>: patients presenting an increase of 50% or more in their leukocyte count at the end of treatment <b>Platelet response</b>: patients presenting an increase of 50% or more in their platelet count at the end of treatment <b>Spleen response</b>: a 2 cm or more reduction in spleen size palpation at the end of treatment <b>Clinical cure:</b> no death, recurrence, hepatosplenomegaly or hematological abnormalities <b>IR</b>: 25–75% interquartile range.</p

Factors associated with a poor outcome in VL (at 6 months after VL diagnosis) in the univariate analysis.

<p><b>VL</b>: visceral leishmaniasis <b>IR</b>: 25–75% interquartile range.</p>§<p>in all cases, refers to the use of inhaled drugs derived from cocaine.</p

Treatment switching and adverse events observed during initial drug treatment of VL.

<p>Treatment switching and adverse events observed during initial drug treatment of VL.</p

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications