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dc.contributor.authorHorrillo, Luis
dc.contributor.authorCastro, Alicia
dc.contributor.authorMatía, Belén
dc.contributor.authorMolina, Laura
dc.contributor.authorGarcía-Martínez, Jesús
dc.contributor.authorJaqueti, Jerónimo
dc.contributor.authorGarcía-Arata, Isabel
dc.contributor.authorCarrillo, Eugenia 
dc.contributor.authorMoreno, Javier 
dc.contributor.authorRuiz-Giardin, José Manuel
dc.contributor.authorSan Martín, Juan
dc.date.accessioned2019-10-11T07:46:57Z
dc.date.available2019-10-11T07:46:57Z
dc.date.issued2019-07-24
dc.identifier.citationParasit Vectors. 2019 Jul 24;12(1):359.es_ES
dc.identifier.issn1756-3305es_ES
dc.identifier.urihttp://hdl.handle.net/20.500.12105/8494
dc.description.abstractBACKGROUND: An outbreak of leishmaniasis caused by Leishmania infantum was declared in the southwest of the Madrid region (Spain) in June 2009. This provided a unique opportunity to compare the management of visceral leishmaniasis (VL) in immunocompetent adults (IC-VL), patients with HIV (HIV-VL) and patients receiving immunosuppressants (IS-VL). METHODS: A cohort of adults with VL, all admitted to the Hospital Universitario de Fuenlabrada between June 2009 and June 2018, were monitored in this observational study, recording their personal, epidemiological, analytical, diagnostic, treatment and outcome variables. RESULTS: The study population was made up of 111 patients with VL (10% HIV-VL, 14% IS-VL, 76% IC-VL). Seventy-one percent of the patients were male; the mean age was 45 years (55 years for the IS-VL patients, P = 0.017). Fifty-four percent of the IC-VL patients were of sub-Saharan origin (P = 0.001). Fever was experienced by 98% of the IC-VL patients vs 73% of the LV-HIV patients (P = 0.003). Plasma ferritin was > 1000 ng/ml in 77% of the IC-VL patients vs 17% of the LV-HIV patients (P = 0.007). Forty-two percent of patients fulfilled the criteria for haemophagocytic lymphohistiocytosis. RDT (rK39-ICT) serological analysis returned sensitivity and specificity values of 45% and 99%, respectively, and ELISA/iIFAT returned 96% and 89%, respectively, with no differences in this respect between patient groups. Fourteen (13.0%) patients with VL experienced treatment failure, eight of whom were in the IC-VL group. Treatment with < 21 mg/kg (total) liposomal amphotericin B (LAB) was associated with treatment failure in the IC-VL patients [P = 0.002 (OR: 14.7; 95% CI: 2.6-83.3)]. CONCLUSIONS: IS-VL was more common than HIV-VL; the lack of experience in dealing with IS-VL is a challenge that needs to be met. The clinical features of the patients in all groups were similar, although the HIV-VL patients experienced less fever and had lower plasma ferritin concentrations. RDT (rK39-ICT) analysis returned a good specificity value but a much poorer sensitivity value than reported in other scenarios. The patients with HIV-VL, IS-VL and IC-VL returned similar serological results. Current guidelines for treatment seem appropriate, but the doses of LAB required to treat patients with HIV-VL and IS-VL are poorly defined.es_ES
dc.description.sponsorshipThis work received financial support from the Red de Investigación Cooperativa en Enfermedades Tropicales (RICET) (RD12/0018/0008; RD16/0027/0017) (ISCIII) and the FEDER.es_ES
dc.language.isoenges_ES
dc.publisherBioMed Central (BMC) es_ES
dc.type.hasVersionVoRes_ES
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectDiagnosises_ES
dc.subjectHIVes_ES
dc.subjectImmunocompromised hostes_ES
dc.subjectLeishmania infantumes_ES
dc.subjectOutbreakes_ES
dc.subjectTherapyes_ES
dc.subjectVisceral leishmaniasises_ES
dc.subject.meshAdult es_ES
dc.subject.meshAged es_ES
dc.subject.meshAntigens, Protozoan es_ES
dc.subject.meshCollections as Topic es_ES
dc.subject.meshDelayed Diagnosis es_ES
dc.subject.meshDisease Outbreaks es_ES
dc.subject.meshFemale es_ES
dc.subject.meshHIV Infections es_ES
dc.subject.meshHumans es_ES
dc.subject.meshImmunocompetence es_ES
dc.subject.meshImmunosuppressive Agents es_ES
dc.subject.meshLeishmania infantum es_ES
dc.subject.meshLeishmaniasis, Visceral es_ES
dc.subject.meshLongitudinal Studies es_ES
dc.subject.meshMale es_ES
dc.subject.meshMiddle Aged es_ES
dc.subject.meshSexual and Gender Minorities es_ES
dc.subject.meshSpain es_ES
dc.subject.meshTime Factors es_ES
dc.subject.meshTreatment Outcome es_ES
dc.subject.meshYoung Adult es_ES
dc.titleClinical aspects of visceral leishmaniasis caused by L. infantum in adults. Ten years of experience of the largest outbreak in Europe: what have we learned?es_ES
dc.typejournal articlees_ES
dc.rights.licenseAtribución 4.0 Internacional*
dc.identifier.pubmedID31340851es_ES
dc.format.volume12es_ES
dc.format.number1es_ES
dc.format.page359es_ES
dc.identifier.doi10.1186/s13071-019-3628-zes_ES
dc.contributor.funderRETICS-Investigación colaborativa en Enfermedades Tropicales (RICET-ISCIII) (España) 
dc.description.peerreviewedes_ES
dc.identifier.e-issn1756-3305es_ES
dc.relation.publisherversionhttps://doi.org/10.1186/s13071-019-3628-zes_ES
dc.identifier.journalParasites & vectorses_ES
dc.repisalud.centroISCIII::Centro Nacional de Microbiologíaes_ES
dc.repisalud.institucionISCIIIes_ES
dc.relation.projectIDinfo:eu-repo/grantAgreement/ES/RD12/0018/0008es_ES
dc.relation.projectIDinfo:eu-repo/grantAgreement/ES/RD16/0027/0017es_ES
dc.rights.accessRightsopen accesses_ES


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Atribución 4.0 Internacional
Este Item está sujeto a una licencia Creative Commons: Atribución 4.0 Internacional