Visceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trends

Hdl Handle:
http://hdl.handle.net/10144/114020
Title:
Visceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trends
Authors:
Gorski, Stanislaw; Collin, Simon M; Ritmeijer, Koert; Keus, Kees; Gatluak, Francis; Mueller, Marius; Davidson, Robert N
Journal:
PLoS Neglected Tropical Diseases
Abstract:
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.
Affiliation:
Médecins Sans Frontières, Amsterdam, The Netherlands; Department of Social Medicine, University of Bristol, Bristol, United Kingdom; Department of Infection and Tropical Medicine, Northwick Park Hospital, Harrow, United Kingdom
Issue Date:
8-Jun-2010
URI:
http://hdl.handle.net/10144/114020
DOI:
10.1371/journal.pntd.0000705
PubMed ID:
20544032
Additional Links:
http://www.tropicalmedandhygienejrnl.net/article/S0035-9203(10)00116-1/abstract
Submitted date:
2010-10-14
Type:
Article
Language:
en
ISSN:
1935-2735
Appears in Collections:
Leishmaniasis/Kala Azar

Full metadata record

DC FieldValue Language
dc.contributor.authorGorski, Stanislawen
dc.contributor.authorCollin, Simon Men
dc.contributor.authorRitmeijer, Koerten
dc.contributor.authorKeus, Keesen
dc.contributor.authorGatluak, Francisen
dc.contributor.authorMueller, Mariusen
dc.contributor.authorDavidson, Robert Nen
dc.date.accessioned2010-10-29T14:45:11Z-
dc.date.available2010-10-29T14:45:11Z-
dc.date.issued2010-06-08-
dc.date.submitted2010-10-14-
dc.identifier.citationPLoS Negl Trop Dis 2010;4(6):e705en
dc.identifier.issn1935-2735-
dc.identifier.pmid20544032-
dc.identifier.doi10.1371/journal.pntd.0000705-
dc.identifier.urihttp://hdl.handle.net/10144/114020-
dc.description.abstractBACKGROUND: 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.en
dc.language.isoenen
dc.relation.urlhttp://www.tropicalmedandhygienejrnl.net/article/S0035-9203(10)00116-1/abstracten
dc.rightsArchived with thanks to PLoS Neglected Tropical Diseasesen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAge Factorsen
dc.subject.meshChi-Square Distributionen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshFemaleen
dc.subject.meshLeishmaniasis, Visceralen
dc.subject.meshLogistic Modelsen
dc.subject.meshMaleen
dc.subject.meshOrgan Sizeen
dc.subject.meshRecurrenceen
dc.subject.meshRetrospective Studiesen
dc.subject.meshRisk Factorsen
dc.subject.meshSpleenen
dc.subject.meshSudanen
dc.titleVisceral leishmaniasis relapse in Southern Sudan (1999-2007): a retrospective study of risk factors and trendsen
dc.typeArticleen
dc.contributor.departmentMédecins Sans Frontières, Amsterdam, The Netherlands; Department of Social Medicine, University of Bristol, Bristol, United Kingdom; Department of Infection and Tropical Medicine, Northwick Park Hospital, Harrow, United Kingdomen
dc.identifier.journalPLoS Neglected Tropical Diseasesen

Related articles on PubMed

All Items in MSF are protected by copyright, with all rights reserved, unless otherwise indicated.