Risk factors, clinical features and outcomes of visceral leishmaniasis in solid-organ transplant recipients: a retrospective multicenter case–control study. (January 2015)

• Record Type: Journal Article
• Authors: Clemente, W.; Vidal, E.; Girão, E.; Ramos, A.S.D.; Govedic, F.; Merino, E.; Muñoz, P.; Sabé, N.; Cervera, C.; Cota, G.F.; Cordero, E.; Mena, A.; Montejo, M.; López-Medrano, F.; Aguado, J.M.; Fernandes, P.; Valerio, M.; Carratalá, J.; Moreno, A.; Oliveira, J.; Mourão, P.H.O.; Torre-Cisneros, J.
• Is Part Of: Clinical microbiology and infection. Volume 21:Number 1(2015:Jan.)
• Page Start: 89
• Page End: 95
• Publication Date: 2015-01
• Subjects: Parasitic infection -- posttransplant infection -- solid-organ transplant -- tropical diseases -- visceral leishmaniasis; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2014.09.002
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: 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.