Hematological and Clinical Features Associated with Initial Poor Treatment Outcomes in Visceral Leishmaniasis Patients with and without HIV Coinfection in Gondar, Northwest Ethiopia.
Hematological and Clinical Features Associated with Initial Poor Treatment Outcomes in Visceral Leishmaniasis Patients with and without HIV Coinfection in Gondar, Northwest Ethiopia.
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DOI：
10.3390/tropicalmed8010036
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发表时间：
2023-01-04
影响因子：
2.9
通讯作者：
Abebe T
中科院分区：
文献类型：
--
作者：
Ademe M;Osorio Y;Howe R;Atnafu S;Mulaw T;Fikre H;Travi BL;Hailu A;Melby PC;Abebe T
埃塞俄比亚是利什曼病负担较高的国家之一。在这篇回顾中，我们旨在确定与内脏利什曼病(VL)患者最初不良治疗结果相关的血液学和临床特征。本研究中的大多数VL病例有白细胞减少(94.3%)、血小板减少(87.1%)和贫血(85.9%)。HIV合并感染占VL病例的7.0%(n=23)。在该中心，没有HIV合并感染的VL患者接受硫代葡萄糖酸钠和帕罗霉素的联合治疗，而HIV合并感染的患者接受AmBisome和米替福辛联合治疗。HIV阳性和HIV阴性内脏利什曼病患者治疗结束治愈率分别为52.2%和96.9%。HIV阳性和HIV阴性病例的病死率分别为34.8%和2.7%。总体而言，这项研究中的死亡患者在入院时更有可能感染艾滋病毒(55.0%比4.1%，p<；0.001)、败血症(15.0%比1.4%，p=0.019)和呼吸困难(40.0%比2.7%，p<；0.001)。在这方面，需要特别注意入院时重叠疾病的管理，包括败血症、艾滋病毒和呼吸困难，以改善VL患者的治疗结果。目前对艾滋病毒合并感染内脏利什曼病患者的联合治疗，即AmBisome和Miltefosine联合疗法的不足，需要进一步关注，因为它需要新的治疗方式。
Ethiopia is among the countries with a high leishmaniasis burden. In this retrospective review, we aimed to determine hematological and clinical features associated with initial poor treatment outcomes of visceral leishmaniasis (VL) patients. The majority of VL cases in this study had leucopenia (94.3%), thrombocytopenia (87.1%), and anemia (85.9%). HIV coinfection was present in 7.0% (n = 23) of VL cases. At the center, VL patients without HIV coinfection were treated with sodium stibogluconate and paromomycin combination, whereas HIV coinfected cases were treated with AmBisome and miltefosine combination therapy. End-of-treatment cure rates among HIV-positive and HIV-negative visceral leishmaniasis cases, respectively, were 52.2% and 96.9%. Case fatality rates were 34.8% and 2.7% in HIV-positive and HIV-negative cases, respectively. Overall, non-survivors in this study were more likely to have HIV (55.0% vs. 4.1%, p < 0.001), sepsis (15.0% vs. 1.4%, p = 0.019), and dyspnea (40.0% vs. 2.7%, p < 0.001) at admission. In this regard, particular attention to the management of superimposed disease conditions at admission, including sepsis, HIV, and dyspnea, is needed to improve VL patients’ treatment outcomes. The inadequacy of the current treatments, i.e., AmBisome and miltefosine combination therapy, for HIV coinfected visceral leishmaniasis patients requires further attention as it calls for new treatment modalities.
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通讯作者：
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影响因子：
3.8
作者：
Tamiru A;Mohammed R;Atnafu S;Medhin G;Hailu A
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