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Free Content Risk factors for relapse of visceral leishmaniasis in Georgia

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Abstract:

Summary The number of relapses in patients treated for visceral leishmaniasis (VL) has increased, thus identifying prognostic factors may aid decisions on treatment. Demographic and clinical information was abstracted from medical records of patients diagnosed and treated in Georgia from 2002 to 2004. The 300 persons with VL were primarily children <5 years (73.3%), and ∼44% had delays in diagnosis of more than 30 days from symptom onset. All patients received standard therapy with pentavalent antimony (20 mg/kg/day), most for 20–25 days. Factors significantly associated with VL relapse were delay in diagnosis for >90 days (RR = 4.21, 95% CI: 1.58, 11.16), haemoglobin level <60 g/l (RR = 11.96, 95% CI: 4.12, 34.76) and age <1 year (RR = 2.36, 95% CI: 0.96, 5.80). Physician and public education is needed to reduce delays in diagnosis. Prolonging treatment for 30 days (e.g. WHO recommendation) or implementing new regimens may reduce the number of relapses.

French
Le nombre de rechutes chez les patients traités pour la leishmaniose viscérale (LV) a augmenté. Dès lors identifier les facteurs de pronostiques pourrait faciliter les décisions sur le traitement. Les informations démographiques et cliniques ont été extraites des dossiers médicaux de patients diagnostiqués et traités en Géorgie de 2002 à 2004. Les 300 personnes avec LV étaient principalement des enfants < 5 ans (73,3%) et environ 44% ont connu des retards de plus de 30 jours dans le diagnostic depuis l’apparition des symptômes. Tous les patients ont reçu un traitement standard à l’antimoine pentavalent (20 mg/kg/jour), la plupart durant 20 à 25 jours. Les facteurs significativement associés à la rechute de la LV étaient le retard dans le diagnostic > 90 jours (RR = 4,21; IC95%: 1,58–11,16), le taux d’hémoglobine < 60 g/L (RR = 11,96; IC95%: 4,12–34,76) et l’âge < 1 an (RR = 2,36; IC95%: 0,96–5,80). La formation des médecins et du public est nécessaire pour réduire les retards dans le diagnostic. Le prolongement du traitement à 30 jours (e.g. recommandation de l’OMS) ou l’implémentation de nouveaux schémas thérapeutiques pourraient réduire le nombre de rechutes.

Keywords: Georgia; Géorgie; Recaída; facteurs de risque; factores de riesgo; leishmaniasis visceral; leishmaniose viscérale; rechute; relapse; risk factors; visceral leishmaniasis

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2010.02694.x

Affiliations: 1:  Maternal and Child Care Union, Tbilisi, Georgia 2:  NY State Department of Health, Albany, NY, USA 3:  S.Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia 4:  School of Public Health, State University of New York, Albany, NY, USA

Publication date: February 1, 2011

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