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Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil.
Int J Infect Dis. 2020 Jun; 95:44-49.IJ

Abstract

OBJECTIVES

Visceral leishmaniasis (VL) is a public health threat for several tropical countries, including Brazil. Therapy failures and relapses aggravate VL morbidity and mortality. Our study aimed at identifying predictors of relapse and thus contributes to directing therapeutic options and patient follow-up.

METHODS

A nonconcurrent cohort of 571 subjects who completed successful therapy for VL in the city of Bauru, São Paulo State, Brazil, was followed for 24 months in order to identify the incidence and predictors of relapse. Extensive review of medical charts and laboratory files was conducted. Univariate and multivariable Cox regression models were used to identify predictors for the outcome of interest. A hierarchical strategy was used for variable selection in multivariable models.

RESULTS

Relapses occurred in 6.8% of treated subjects, after a median of 6 months (interquartile range, 4-9). In a comprehensive multivariable model, relapse was associated with: HIV-coinfection (hazard ratio [HR], 7.47; 95% confidence interval [CI], 2.58-21.55); the presence of lower limb edema (HR, 6.06; 95%CI, 1.38-26.77) and low platelet count upon admission (HR for platelet count × 1000, 0.99; 95%CI, 0.98-0.99) ; and secondary pneumonia (HR, 5.49; 95%CI, 1.49-20.18). On the other hand, therapy with Liposomal Amphotericin (as opposed to Antimoniate) was not independently associated with relapse (HR, 5.97; 95%CI, 0.63-56.29).

CONCLUSION

Besides reinforcing the impact of HIV coinfection on the outcome of VL, our study points to clinical and laboratory findings that characterize patients who were more likely to relapse. Those groups should be more closely followed, and possibly could benefit from novel therapeutic options.

Authors+Show Affiliations

Postgraduate Program in Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.Department of Veterinary Hygiene and Public Health, Veterinary Faculty, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.Postgraduate Program in Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil. Electronic address: cmfortaleza@uol.com.br.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32088340

Citation

Simão, José Cláudio, et al. "Predictors of Relapse of Visceral Leishmaniasis in Inner São Paulo State, Brazil." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 95, 2020, pp. 44-49.
Simão JC, Victória C, Fortaleza CMCB. Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil. Int J Infect Dis. 2020;95:44-49.
Simão, J. C., Victória, C., & Fortaleza, C. M. C. B. (2020). Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 95, 44-49. https://doi.org/10.1016/j.ijid.2020.02.028
Simão JC, Victória C, Fortaleza CMCB. Predictors of Relapse of Visceral Leishmaniasis in Inner São Paulo State, Brazil. Int J Infect Dis. 2020;95:44-49. PubMed PMID: 32088340.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil. AU - Simão,José Cláudio, AU - Victória,Cassiano, AU - Fortaleza,Carlos Magno Castelo Branco, Y1 - 2020/02/20/ PY - 2019/12/29/received PY - 2020/02/12/revised PY - 2020/02/14/accepted PY - 2020/2/24/pubmed PY - 2020/2/24/medline PY - 2020/2/24/entrez KW - Predictors of relapse KW - Visceral leishmaniasis KW - Visceral leishmaniasis-HIV coinfection SP - 44 EP - 49 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int. J. Infect. Dis. VL - 95 N2 - OBJECTIVES: Visceral leishmaniasis (VL) is a public health threat for several tropical countries, including Brazil. Therapy failures and relapses aggravate VL morbidity and mortality. Our study aimed at identifying predictors of relapse and thus contributes to directing therapeutic options and patient follow-up. METHODS: A nonconcurrent cohort of 571 subjects who completed successful therapy for VL in the city of Bauru, São Paulo State, Brazil, was followed for 24 months in order to identify the incidence and predictors of relapse. Extensive review of medical charts and laboratory files was conducted. Univariate and multivariable Cox regression models were used to identify predictors for the outcome of interest. A hierarchical strategy was used for variable selection in multivariable models. RESULTS: Relapses occurred in 6.8% of treated subjects, after a median of 6 months (interquartile range, 4-9). In a comprehensive multivariable model, relapse was associated with: HIV-coinfection (hazard ratio [HR], 7.47; 95% confidence interval [CI], 2.58-21.55); the presence of lower limb edema (HR, 6.06; 95%CI, 1.38-26.77) and low platelet count upon admission (HR for platelet count × 1000, 0.99; 95%CI, 0.98-0.99) ; and secondary pneumonia (HR, 5.49; 95%CI, 1.49-20.18). On the other hand, therapy with Liposomal Amphotericin (as opposed to Antimoniate) was not independently associated with relapse (HR, 5.97; 95%CI, 0.63-56.29). CONCLUSION: Besides reinforcing the impact of HIV coinfection on the outcome of VL, our study points to clinical and laboratory findings that characterize patients who were more likely to relapse. Those groups should be more closely followed, and possibly could benefit from novel therapeutic options. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/32088340/Predictors_of_relapse_of_visceral_leishmaniasis_in_inner_São_Paulo_State,_Brazil L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(20)30086-2 DB - PRIME DP - Unbound Medicine ER -
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