Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1016/j.ijid.2020.02.028 http://hdl.handle.net/11449/200291 |
Resumo: | Objectives: Visceral leishmaniasis (VL) is a public health threat for several tropical countries, including Brazil. Therapy failures and relapses aggravate VL morbidity and mortality. Our study aimed at identifying predictors of relapse and thus contributes to directing therapeutic options and patient follow-up. Methods: A nonconcurrent cohort of 571 subjects who completed successful therapy for VL in the city of Bauru, São Paulo State, Brazil, was followed for 24 months in order to identify the incidence and predictors of relapse. Extensive review of medical charts and laboratory files was conducted. Univariate and multivariable Cox regression models were used to identify predictors for the outcome of interest. A hierarchical strategy was used for variable selection in multivariable models. Results: Relapses occurred in 6.8% of treated subjects, after a median of 6 months (interquartile range, 4–9). In a comprehensive multivariable model, relapse was associated with: HIV-coinfection (hazard ratio [HR], 7.47; 95% confidence interval [CI], 2.58–21.55); the presence of lower limb edema (HR, 6.06; 95%CI, 1.38–26.77) and low platelet count upon admission (HR for platelet count × 1000, 0.99; 95%CI, 0.98–0.99) ; and secondary pneumonia (HR, 5.49; 95%CI, 1.49–20.18). On the other hand, therapy with Liposomal Amphotericin (as opposed to Antimoniate) was not independently associated with relapse (HR, 5.97; 95%CI, 0.63–56.29). Conclusion: Besides reinforcing the impact of HIV coinfection on the outcome of VL, our study points to clinical and laboratory findings that characterize patients who were more likely to relapse. Those groups should be more closely followed, and possibly could benefit from novel therapeutic options. |
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Predictors of relapse of visceral leishmaniasis in inner São Paulo State, BrazilPredictors of relapseVisceral leishmaniasisVisceral leishmaniasis-HIV coinfectionObjectives: Visceral leishmaniasis (VL) is a public health threat for several tropical countries, including Brazil. Therapy failures and relapses aggravate VL morbidity and mortality. Our study aimed at identifying predictors of relapse and thus contributes to directing therapeutic options and patient follow-up. Methods: A nonconcurrent cohort of 571 subjects who completed successful therapy for VL in the city of Bauru, São Paulo State, Brazil, was followed for 24 months in order to identify the incidence and predictors of relapse. Extensive review of medical charts and laboratory files was conducted. Univariate and multivariable Cox regression models were used to identify predictors for the outcome of interest. A hierarchical strategy was used for variable selection in multivariable models. Results: Relapses occurred in 6.8% of treated subjects, after a median of 6 months (interquartile range, 4–9). In a comprehensive multivariable model, relapse was associated with: HIV-coinfection (hazard ratio [HR], 7.47; 95% confidence interval [CI], 2.58–21.55); the presence of lower limb edema (HR, 6.06; 95%CI, 1.38–26.77) and low platelet count upon admission (HR for platelet count × 1000, 0.99; 95%CI, 0.98–0.99) ; and secondary pneumonia (HR, 5.49; 95%CI, 1.49–20.18). On the other hand, therapy with Liposomal Amphotericin (as opposed to Antimoniate) was not independently associated with relapse (HR, 5.97; 95%CI, 0.63–56.29). Conclusion: Besides reinforcing the impact of HIV coinfection on the outcome of VL, our study points to clinical and laboratory findings that characterize patients who were more likely to relapse. Those groups should be more closely followed, and possibly could benefit from novel therapeutic options.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Postgraduate Program in Tropical Diseases Botucatu Medical School São Paulo State University (UNESP)Department of Veterinary Hygiene and Public Health Veterinary Faculty São Paulo State University (UNESP)Department of Tropical Diseases Botucatu Medical School São Paulo State University (UNESP)Postgraduate Program in Tropical Diseases Botucatu Medical School São Paulo State University (UNESP)Department of Veterinary Hygiene and Public Health Veterinary Faculty São Paulo State University (UNESP)Department of Tropical Diseases Botucatu Medical School São Paulo State University (UNESP)CNPq: 310547/2018-0Universidade Estadual Paulista (Unesp)Simão, José Cláudio [UNESP]Victória, Cassiano [UNESP]Fortaleza, Carlos Magno Castelo Branco [UNESP]2020-12-12T02:02:45Z2020-12-12T02:02:45Z2020-06-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article44-49http://dx.doi.org/10.1016/j.ijid.2020.02.028International Journal of Infectious Diseases, v. 95, p. 44-49.1878-35111201-9712http://hdl.handle.net/11449/20029110.1016/j.ijid.2020.02.0282-s2.0-85083388670Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengInternational Journal of Infectious Diseasesinfo:eu-repo/semantics/openAccess2021-10-23T10:11:15Zoai:repositorio.unesp.br:11449/200291Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462021-10-23T10:11:15Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil |
title |
Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil |
spellingShingle |
Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil Simão, José Cláudio [UNESP] Predictors of relapse Visceral leishmaniasis Visceral leishmaniasis-HIV coinfection |
title_short |
Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil |
title_full |
Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil |
title_fullStr |
Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil |
title_full_unstemmed |
Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil |
title_sort |
Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil |
author |
Simão, José Cláudio [UNESP] |
author_facet |
Simão, José Cláudio [UNESP] Victória, Cassiano [UNESP] Fortaleza, Carlos Magno Castelo Branco [UNESP] |
author_role |
author |
author2 |
Victória, Cassiano [UNESP] Fortaleza, Carlos Magno Castelo Branco [UNESP] |
author2_role |
author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) |
dc.contributor.author.fl_str_mv |
Simão, José Cláudio [UNESP] Victória, Cassiano [UNESP] Fortaleza, Carlos Magno Castelo Branco [UNESP] |
dc.subject.por.fl_str_mv |
Predictors of relapse Visceral leishmaniasis Visceral leishmaniasis-HIV coinfection |
topic |
Predictors of relapse Visceral leishmaniasis Visceral leishmaniasis-HIV coinfection |
description |
Objectives: Visceral leishmaniasis (VL) is a public health threat for several tropical countries, including Brazil. Therapy failures and relapses aggravate VL morbidity and mortality. Our study aimed at identifying predictors of relapse and thus contributes to directing therapeutic options and patient follow-up. Methods: A nonconcurrent cohort of 571 subjects who completed successful therapy for VL in the city of Bauru, São Paulo State, Brazil, was followed for 24 months in order to identify the incidence and predictors of relapse. Extensive review of medical charts and laboratory files was conducted. Univariate and multivariable Cox regression models were used to identify predictors for the outcome of interest. A hierarchical strategy was used for variable selection in multivariable models. Results: Relapses occurred in 6.8% of treated subjects, after a median of 6 months (interquartile range, 4–9). In a comprehensive multivariable model, relapse was associated with: HIV-coinfection (hazard ratio [HR], 7.47; 95% confidence interval [CI], 2.58–21.55); the presence of lower limb edema (HR, 6.06; 95%CI, 1.38–26.77) and low platelet count upon admission (HR for platelet count × 1000, 0.99; 95%CI, 0.98–0.99) ; and secondary pneumonia (HR, 5.49; 95%CI, 1.49–20.18). On the other hand, therapy with Liposomal Amphotericin (as opposed to Antimoniate) was not independently associated with relapse (HR, 5.97; 95%CI, 0.63–56.29). Conclusion: Besides reinforcing the impact of HIV coinfection on the outcome of VL, our study points to clinical and laboratory findings that characterize patients who were more likely to relapse. Those groups should be more closely followed, and possibly could benefit from novel therapeutic options. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-12-12T02:02:45Z 2020-12-12T02:02:45Z 2020-06-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1016/j.ijid.2020.02.028 International Journal of Infectious Diseases, v. 95, p. 44-49. 1878-3511 1201-9712 http://hdl.handle.net/11449/200291 10.1016/j.ijid.2020.02.028 2-s2.0-85083388670 |
url |
http://dx.doi.org/10.1016/j.ijid.2020.02.028 http://hdl.handle.net/11449/200291 |
identifier_str_mv |
International Journal of Infectious Diseases, v. 95, p. 44-49. 1878-3511 1201-9712 10.1016/j.ijid.2020.02.028 2-s2.0-85083388670 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
International Journal of Infectious Diseases |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
44-49 |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
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1797789309003104256 |