New challenges in the epidemiology and treatment of visceral leishmaniasis in periurban areas

Abstract

Visceral leishmaniasis [VL] represents a major public health problem in many areas of the world. This review focuses on the impact of periurbanization on the epidemiology and treatment of VL, using Brazil as an example. VL continues to be mostly a disease of poverty with impact on families. However, the disease has expanded in Latin America, with foci reported as far south as Argentina. There is an increasing overlap of Leishmania infantum chagasi and HIV infections and other immunosuppressive conditions, resulting in VL emerging as an opportunistic infection. This new setting poses new challenges for VL disease control and patient management.

Epidemiological, clinical and laboratory aspects of human visceral leishmaniasis (HVL) associated with human immunodeficiency virus (HIV) coinfection: a systematic review

“…Clinical manifestations found in this study, such as fever, splenomegaly, weight loss, asthenia, anaemia and/or pallor, hepatomegaly, cough and diarrhoea were similar to the information mentioned by other studies (Granthon et al , 2007; Craft et al , 2010; Dupnik et al , 2011; de Souza et al , 2012 a ), except for splenomegaly (91%), which in this review was lower. Clinical manifestations are generally similar between HVL and HVL/HIV, except for the presence of more frequent diarrhoea in coinfection (de Souza et al , 2012 a ; Lima et al , 2013; de Albuquerque et al , 2014), which may be associated with intestinal infections, concomitant use of antibiotics and/or antiretrovirals (de Souza et al , 2012 a ), as well as with parasitism of Leishmania amastigotes in intestinal mucosal cells, increasing permeability (Santos-Oliveira et al , 2011, 2013).…”

“…However, relapses may occur even after therapy and prophylaxis, and when HAART is used (Coura-Vital et al , 2014; Barbosa Júnior et al , 2015), however, 48% of HIV-infected patients have contracted VL, even when in use of HAART. Nevertheless, it does not seem to completely prevent relapse (Dupnik et al , 2011), since 20% had relapses, and 91% of coinfected patients were using HAART during follow-up, suggesting that the presence of the parasite may affect both diseases (Santos-Oliveira et al , 2010). The BMH and the WHO suggest that HAART should be done after HVL treatment and patient stabilization both clinically and haematologically (Ministério da Saúde., 2015).…”

“…Coinfection can be fatal if not diagnosed and treated properly in a timely manner. In HVL/HIV, it may be more aggressive or may not present clinical signs characteristic of HVL, such as hepatosplenomegaly (Dupnik et al , 2011), making the diagnosis more difficult (de Almeida e Cavalcanti et al , 2012; Abass et al , 2015), since clinical manifestations are similar to other diseases (Cota et al , 2013 b ). Parasitological examination of bone marrow is the gold standard diagnostic test for HVL in people with HIV (Silva et al , 2013; Costa et al , 2013 b ).…”

“…The patient should be followed up indefinitely (Ministério da Saúde, 2015). Treatment efficacy and low occurrence of relapses may also be linked to the use of highly active antiretroviral therapy (HAART) (Dupnik et al , 2011; Lima et al , 2013).…”

Epidemiological aspects and spatial patterns of human visceral leishmaniasis in Brazil

“…The method for diagnosing HVL used with the greatest number of positive cases was the indirect immunofluorescence test. This test is more effective than the parasitological test, since it is based on the antibody response (World Health Organization., 2010; Dupnik et al ., 2011;Souza et al ., 2012; Cota et al ., 2013, 2014; Albuquerque et al ., 2014; Druzian et al ., 2015; Távora et al ., 2015).…”