Pasquau F, Ena J, Sanchez R, Cuadrado J M, Amador C, Flores J, Benito C, Redondo C, Lacruz J, Abril V, Onofre J
Department of Internal Medicine-HIV Unit, Marina Baixa Hospital, Partida de Galandú 5, 03570 Villajoyosa, Alicante, Spain.
Eur J Clin Microbiol Infect Dis. 2005 Jun;24(6):411-8. doi: 10.1007/s10096-005-1342-6.
The clinical presentation of visceral leishmaniasis shares similarities with other geographically specific infectious diseases associated with AIDS in terms of relapsing course and atypical presentation. However, visceral leishmaniasis has not, until now, been included in the AIDS case definition. The aim of this study was to describe the clinical features and determinants for relapse and case-fatality of visceral leishmaniasis in HIV-infected patients from a Spanish Mediterranean area. A chart review was conducted in 16 hospitals in the autonomous communities of Valencia and Murcia (Spain). From 1988 to 2001, a total of 228 episodes of visceral leishmaniasis were diagnosed in 155 HIV-infected patients by the detection of amastigotes in bone marrow aspirates or in other tissue samples. Most patients had advanced HIV disease, with a median CD4(+) lymphocyte cell count of 55 cells x 10(9) l, and 56% of them had a previous AIDS-indicator disease. The median duration of follow-up was 8.4 months. HIV-infected patients with visceral leishmaniasis presented with fever (76%), hepatomegaly (77%), splenomegaly (78%), and varying degrees of cytopenias. Leishmania was detected in atypical sites in 22 (14%) patients. A total of 37 (24%) patients had a relapse of visceral leishmaniasis. Female gender was a risk factor for relapse, whereas administration of secondary prophylaxis for visceral leishmaniasis and a completed therapy for visceral leishmaniasis were protective factors against relapse. A total of 86 (54%) patients died. Independent determinants for survival were CD4(+) lymphocyte cell count, completed therapy for leishmania, and secondary prophylaxis for visceral leishmaniasis. The findings show that, in HIV-infected patients, visceral leishmaniasis occurs in late stages of HIV disease and often has a relapsing course. Secondary prophylaxis reduces the risk of relapse. Visceral leishmaniasis in the HIV-infected population should be included in the CDC clinical category C for the definition of AIDS in the same way that other geographically specific opportunistic infections are included.
内脏利什曼病的临床表现与其他与艾滋病相关的特定地理区域的传染病在复发过程和非典型表现方面有相似之处。然而，直到现在，内脏利什曼病尚未被纳入艾滋病病例定义中。本研究的目的是描述西班牙地中海地区HIV感染患者内脏利什曼病的临床特征、复发和病死率的决定因素。对西班牙巴伦西亚和穆尔西亚自治区的16家医院进行了病历回顾。从1988年到2001年，通过在骨髓穿刺物或其他组织样本中检测到无鞭毛体，共诊断出155例HIV感染患者的228次内脏利什曼病发作。大多数患者患有晚期HIV疾病，CD4(+)淋巴细胞计数中位数为55个细胞×10(9)/L，其中56%的患者曾患有艾滋病指示性疾病。随访的中位时间为8.4个月。HIV感染的内脏利什曼病患者表现为发热(76%)、肝肿大(77%)、脾肿大(78%)以及不同程度的血细胞减少。22例(14%)患者在非典型部位检测到利什曼原虫。共有37例(24%)患者出现内脏利什曼病复发。女性是复发的危险因素，而给予内脏利什曼病二级预防和完成内脏利什曼病治疗是预防复发的保护因素。共有86例(54%)患者死亡。生存的独立决定因素是CD4(+)淋巴细胞计数、完成利什曼病治疗以及内脏利什曼病二级预防。研究结果表明，在HIV感染患者中，内脏利什曼病发生在HIV疾病的晚期，且往往有复发过程。二级预防可降低复发风险。HIV感染人群中的内脏利什曼病应与其他特定地理区域的机会性感染一样，被纳入美国疾病控制与预防中心艾滋病临床分类C中。
