Visceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trends.
BACKGROUND: Risk factors associated with L. donovani visceral leishmaniasis (VL; kala azar) relapse are poorly characterized. METHODS: We investigated patient characteristics and drug regimens associated with VL relapse using data from Médecins Sans Frontières - Holland (MSF) treatment centres in So...
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ftdoajarticles:oai:doaj.org/article:69557fb19ad846e69f14d4eba128f1fc 2023-05-15T15:13:41+02:00 Visceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trends. Stanislaw Gorski Simon M Collin Koert Ritmeijer Kees Keus Francis Gatluak Marius Mueller Robert N Davidson 2010-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0000705 https://doaj.org/article/69557fb19ad846e69f14d4eba128f1fc EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC2882338?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0000705 https://doaj.org/article/69557fb19ad846e69f14d4eba128f1fc PLoS Neglected Tropical Diseases, Vol 4, Iss 6, p e705 (2010) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2010 ftdoajarticles https://doi.org/10.1371/journal.pntd.0000705 2022-12-31T12:55:39Z BACKGROUND: Risk factors associated with L. donovani visceral leishmaniasis (VL; kala azar) relapse are poorly characterized. METHODS: We investigated patient characteristics and drug regimens associated with VL relapse using data from Médecins Sans Frontières - Holland (MSF) treatment centres in Southern Sudan. We used MSF operational data to investigate trends in VL relapse and associated risk factors. RESULTS: We obtained data for 8,800 primary VL and 621 relapse VL patients treated between 1999 and 2007. Records of previous treatment for 166 VL relapse patients (26.7%) were compared with 7,924 primary VL patients who had no record of subsequent relapse. Primary VL patients who relapsed had larger spleens on admission (Hackett grade >or=3 vs 0, odds ratio (OR) for relapse = 3.62 (95% CI 1.08, 12.12)) and on discharge (Hackett grade >or=3 vs 0, OR = 5.50 (1.84, 16.49)). Age, sex, malnutrition, mobility, and complications of treatment were not associated with risk of relapse, nor was there any trend over time. Treatment with 17-day sodium stibogluconate/paromomycin (SSG/PM) combination therapy vs 30-day SSG monotherapy was associated with increased risk of relapse (OR = 2.08 (1.21, 3.58)) but reduced risk of death (OR = 0.27 (0.20, 0.37)), although these estimates are likely to be residually confounded. MSF operational data showed a crude upward trend in the proportion of VL relapse patients (annual percentage change (APC) = 11.4% (-3.4%, 28.5%)) and a downward trend in deaths (APC = -18.1% (-22.5%, -13.4%)). CONCLUSIONS: Splenomegaly and 17-day SSG/PM vs 30-day SSG were associated with increased risk of VL relapse. The crude upward trend in VL relapses in Southern Sudan may be attributable to improved access to treatment and reduced mortality due to SSG/PM combination therapy. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Azar ENVELOPE(-63.733,-63.733,-64.983,-64.983) PLoS Neglected Tropical Diseases 4 6 e705 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
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English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Stanislaw Gorski Simon M Collin Koert Ritmeijer Kees Keus Francis Gatluak Marius Mueller Robert N Davidson Visceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trends. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND: Risk factors associated with L. donovani visceral leishmaniasis (VL; kala azar) relapse are poorly characterized. METHODS: We investigated patient characteristics and drug regimens associated with VL relapse using data from Médecins Sans Frontières - Holland (MSF) treatment centres in Southern Sudan. We used MSF operational data to investigate trends in VL relapse and associated risk factors. RESULTS: We obtained data for 8,800 primary VL and 621 relapse VL patients treated between 1999 and 2007. Records of previous treatment for 166 VL relapse patients (26.7%) were compared with 7,924 primary VL patients who had no record of subsequent relapse. Primary VL patients who relapsed had larger spleens on admission (Hackett grade >or=3 vs 0, odds ratio (OR) for relapse = 3.62 (95% CI 1.08, 12.12)) and on discharge (Hackett grade >or=3 vs 0, OR = 5.50 (1.84, 16.49)). Age, sex, malnutrition, mobility, and complications of treatment were not associated with risk of relapse, nor was there any trend over time. Treatment with 17-day sodium stibogluconate/paromomycin (SSG/PM) combination therapy vs 30-day SSG monotherapy was associated with increased risk of relapse (OR = 2.08 (1.21, 3.58)) but reduced risk of death (OR = 0.27 (0.20, 0.37)), although these estimates are likely to be residually confounded. MSF operational data showed a crude upward trend in the proportion of VL relapse patients (annual percentage change (APC) = 11.4% (-3.4%, 28.5%)) and a downward trend in deaths (APC = -18.1% (-22.5%, -13.4%)). CONCLUSIONS: Splenomegaly and 17-day SSG/PM vs 30-day SSG were associated with increased risk of VL relapse. The crude upward trend in VL relapses in Southern Sudan may be attributable to improved access to treatment and reduced mortality due to SSG/PM combination therapy. |
format |
Article in Journal/Newspaper |
author |
Stanislaw Gorski Simon M Collin Koert Ritmeijer Kees Keus Francis Gatluak Marius Mueller Robert N Davidson |
author_facet |
Stanislaw Gorski Simon M Collin Koert Ritmeijer Kees Keus Francis Gatluak Marius Mueller Robert N Davidson |
author_sort |
Stanislaw Gorski |
title |
Visceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trends. |
title_short |
Visceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trends. |
title_full |
Visceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trends. |
title_fullStr |
Visceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trends. |
title_full_unstemmed |
Visceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trends. |
title_sort |
visceral leishmaniasis relapse in southern sudan (1999-2007): a retrospective study of risk factors and trends. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2010 |
url |
https://doi.org/10.1371/journal.pntd.0000705 https://doaj.org/article/69557fb19ad846e69f14d4eba128f1fc |
long_lat |
ENVELOPE(-63.733,-63.733,-64.983,-64.983) |
geographic |
Arctic Azar |
geographic_facet |
Arctic Azar |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 4, Iss 6, p e705 (2010) |
op_relation |
http://europepmc.org/articles/PMC2882338?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0000705 https://doaj.org/article/69557fb19ad846e69f14d4eba128f1fc |
op_doi |
https://doi.org/10.1371/journal.pntd.0000705 |
container_title |
PLoS Neglected Tropical Diseases |
container_volume |
4 |
container_issue |
6 |
container_start_page |
e705 |
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1766344214181838848 |