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Comparative Analysis of Pediatric and Adult Visceral Leishmaniasis in Brazil

Rocha, Natália A. MD*; Oliveira, Michelle J. C. MD, MSc*†; Franco, Luiz F. L. G. MD*; Júnior, Geraldo B. Silva MD, MSc*†; Alves, Marília P. MD*; Sampaio, Aline M. MD*; Montenegro, Bárbara R. L. MD*; Vieira, Ana Patrícia F. MD*; Jacinto, Camilla N. MD*; Abreu, Krasnalhia Lívia S. MD*; Daher, Elizabeth F. MD, PhD*

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3182814eae
Original Studies
Abstract

Background: The aim of this study was to compare clinical manifestations, laboratory data, morbidity and mortality between adults and children with visceral leishmaniasis, with a focus on kidney function.

Methods: This was a retrospective cohort study with 432 patients with visceral leishmaniasis diagnosed at 1 center in the northeast of Brazil. Patients were divided into 2 groups according to age (>21 years and ≤21 years old).

Results: The time between onset of symptoms and beginning of treatment was longer in adults (89.5 versus 48.5 days, P < 0.001); signs and symptoms were similar in both groups. Failure of treatment with glucantime was more common in adults (17.6% versus 8.8%, P = 0.008). Acute kidney injury was observed in 160 patients (37.0%), and it was more severe in adults. Risk factors for acute kidney injury in adults were hypokalemia, leukopenia, chills and amphotericin B use. In children, secondary infections were found to increase the risk for acute kidney injury. Overall mortality was 8.8%, and it was significantly higher in adults (12.6% versus 4.1%, P = 0.002).

Conclusions: The adult population had more severe laboratory abnormalities and a worse prognosis, possibly due to delay in diagnosis. Acute kidney injury is prevalent in both groups, and it is usually more severe in adults.

Author Information

From the *Department of Internal Medicine, Division of Nephrology, School of Medicine, Federal University of Ceará; and School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil.

Accepted for publication November 28, 2012.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Elizabeth De Francesco Daher, MD, PhD, Rua Vicente Linhares, 1198, CEP 60270-135, Fortaleza, Ceara, Brazil. E-mail: ef.daher@uol.com.br or geraldobezerrajr@yahoo.com.br.

© 2013 Lippincott Williams & Wilkins, Inc.