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Splenectomy in Patients with Visceral Leishmaniasis Resistant to Conventional Therapy and Secondary Prophylaxis: A Retrospective Cohort.
Reinaldo, Luis G C; Araújo-Júnior, Raimundo J C; Diniz, Thiago M; Moura, Rafael D; Meneses-Filho, Antônio J; Furtado, Caio V V M; Santos, Washington L C; Costa, Dorcas L; Eulálio, Kelsen D; Ferreira, Gabriel R; Costa, Carlos H N.
Afiliação
  • Reinaldo LGC; University Hospital of the Federal University of Piauí, Teresina, Brazil.
  • Araújo-Júnior RJC; Hospital Getúlio Vargas, Teresina, Brazil.
  • Diniz TM; University Hospital of the Federal University of Piauí, Teresina, Brazil.
  • Moura RD; Hospital Getúlio Vargas, Teresina, Brazil.
  • Meneses-Filho AJ; Department of Specialized Medicine, Federal University of Piauí, Teresina, Brazil.
  • Furtado CVVM; University Hospital of the Federal University of Piauí, Teresina, Brazil.
  • Santos WLC; University Hospital of the Federal University of Piauí, Teresina, Brazil.
  • Costa DL; Department of Specialized Medicine, Federal University of Piauí, Teresina, Brazil.
  • Eulálio KD; Department of Community Medicine, Federal University of Piauí, Teresina, Brazil.
  • Ferreira GR; University Hospital of the Federal University of Piauí, Teresina, Brazil.
  • Costa CHN; Oswaldo Cruz Foundation, Gonçalo Moniz Institute, Salvador, Brazil.
Am J Trop Med Hyg ; 107(2): 342-348, 2022 08 17.
Article em En | MEDLINE | ID: mdl-35895427
Some patients with visceral leishmaniasis (VL), or kala-azar, suffer relapses and low quality of life despite adequate drug therapy, especially those co-infected with HIV. Occasionally, physicians indicate splenectomy, but the benefit of the procedure needs to be analyzed systematically. Therefore, a retrospective open cohort study was conducted in Teresina, Brazil. Inpatients from a reference hospital with relapsing VL who had a rescue splenectomy between 2012 and 2019 after the nationally recommended drug therapy failed were studied. The procedure's risks and benefits were assessed in a limited-resource setting. The primary outcomes were surgical complications, complete blood count, CD4+ cell count, hospitalizations, survival time, and medical complications preceding death. Thirteen adult patients received medical and surgical indications of splenectomy (12 men and one woman). Eleven had HIV infection. Two had early and two had late complications. Four died, all of whom were infected with HIV. An additional HIV-coinfected patient, apart from the cohort, died just before surgery. The death rate after surgery was 13.3 overall and 22.1 per 100 person-years among HIV-infected patients (31% overall and 36%, respectively). The impressive rise of complete blood counts and reduction of blood transfusions and hospitalizations were observed among all patients. Also, a meaningful increase in CD4+ cells in HIV-infected patients was noted. Splenectomy may benefit patients with relapsing VL. However, before performing splenectomy, available combined drug therapy for VL should be tried.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por HIV / Leishmaniose Visceral Tipo de estudo: Observational_studies / Risk_factors_studies Aspecto: Patient_preference Limite: Adult / Female / Humans / Male Idioma: En Revista: Am J Trop Med Hyg Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por HIV / Leishmaniose Visceral Tipo de estudo: Observational_studies / Risk_factors_studies Aspecto: Patient_preference Limite: Adult / Female / Humans / Male Idioma: En Revista: Am J Trop Med Hyg Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos