Leishmaniasis Patients Research Articles

The Frequency of Hepatitis B Virus, Hepatitis C Virus, and Human Immunodeficiency Virus Co-infections among Visceral Leishmaniasis Patients and their Impact on Management

ABSTRACT Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) represent significant public health problems and affect around 300 million people globally. Co-infection of HBV and HCV among patients with visceral leishmaniasis (VL) increased the risk of hepatotoxicity during treatment with sodium stibogluconate (SSG). Leishmania/human immunodeficiency virus (HIV) co-infection is emerging as a new clinical form of leishmaniasis. Objective: We aimed to determine the frequency of HBV, HCV, and HIV co-infections among VL patients and the impact on their management. Methods: This was a descriptive cross-sectional hospital-based study conducted during the period March–May 2021 and included 100 participants. Results: More than two-thirds of the participants (71%) were males while the rest were females (29%), with a mean age of 31.32 years. Patients who were HIV positive 9% and 7% were HBV positive, while only 2% were HCV positive. Patients who received the first line of treatment (sodium stibogluconate) were 71% while 29% received the second line of treatment (amphotericin B). Conclusion: Improvement of screening and early detection of viral hepatitis/HIV co-infections with VL may provide effective preventive measures and affect the management options according to the updated protocol.

Evaluation of the Transmission Rate, the Mortality Rate, and the Level of Endemicity Due to Visceral Leishmaniasis at Marsabit County Referral Hospital

The disease Visceral leishmaniasis is a tropical infection spread by female sandflies. This leishmaniasis affects the spleen, the liver, and bone marrow. Globally, between 0.7 million and 1 million cases of visceral leishmaniasis arise yearly. In Kenya, 4000 cases are reported yearly, while 5 million individuals are at risk of infection. If untreated, the visceral leishmaniasis death rate is more than 95%. The study aims to evaluate the mortality and the transmission rate among visceral leishmaniasis patients referred to the Marsabit County referral hospital. The study adopted a retrospective cohort design. The study used secondary data obtained from the Marsabit County referral hospital. The Susceptible, Infected, and Recovered (S.I.R) Model, was incorporated to evaluate the mortality rate, the transmission rate, and the level of endemicity. The findings revealed that the mortality rate, the transmission rate, and the level of endemicity were estimated at 13.19%, 13.67%, and 0.0141, respectively. In conclusion, the mortality rate increases as the transmission rate increase and there is a need for urgent responses from health personnel to reduce the transmission rate to reduce subsequent morbidity and mortality. The study recommended adopting the following measures; the mortality rate was 13.19%, and the prevalence of the disease was higher in males than among females which subsequently increases mortality among males therefore, there is a need to put more attention to males when creating awareness. The transmission rate was 13.67%, this rate can be reduced by reducing risk factors that are responsible for the transmission of visceral leishmaniasis. Creating awareness at the community level and seeking medication on time to reduce mortality from visceral leishmaniasis in Marsabit County.

Systematic Review of Treatment Failure and Clinical Relapses in Leishmaniasis from a Multifactorial Perspective: Clinical Aspects, Factors Associated with the Parasite and Host.

Leishmaniasis is a disease caused by protozoa of the genus Leishmania. Treatment options are limited, and there are frequent cases of treatment failure and clinical relapse. To understand these phenomena better, a systematic review was conducted, considering studies published between 1990 and 2021 in Portuguese, English, and Spanish. The review included 64 articles divided into three categories. Case reports (26 articles) focused on treatment failure and clinical relapse in cutaneous leishmaniasis patients (47.6%), primarily affecting males (74%) and children (67%), regardless of the clinical manifestation. Experimental studies on the parasite (19 articles), particularly with L. major (25%), indicated that alterations in DNA and genic expression (44.82%) played a significant role in treatment failure and clinical relapse. Population data on the human host (19 articles) identified immunological characteristics as the most associated factor (36%) with treatment failure and clinical relapse. Each clinical manifestation of the disease presented specificities in these phenomena, suggesting a multifactorial nature. Additionally, the parasites were found to adapt to the drugs used in treatment. In summary, the systematic review revealed that treatment failure and clinical relapse in leishmaniasis are complex processes influenced by various factors, including host immunology and parasite adaptation.

Serum Zinc Level and Efficacy of Zinc Therapy in Cutaneous Leishmaniasis: a Systematic Review and Meta-analysis.

Cutaneous leishmaniasis is a parasitic skin disease prevalent in many parts of the world. Zinc has been investigated for its potential role in the immune response against Leishmania parasites. This study aimed to systematically review the literature and conduct meta-analyses to evaluate the serum zinc level and efficacy of zinc therapy in cutaneous leishmaniasis. A comprehensive search of electronic databases was performed to find studies reporting serum zinc levels and the efficacy of zinc therapy in cutaneous leishmaniasis. Meta-analyses were conducted using RevMan software (version 5.4), calculating the mean difference for serum zinc levels and risk ratio for the efficacy of zinc therapy. A total of 11 studies with 1009 participants were evaluated. Five of these studies, comprising 637 participants, examined serum zinc levels; the remaining six, involving 372 individuals, examined the effectiveness of zinc therapy in treating cutaneous leishmaniasis. The results showed that the serum zinc level was significantly lower in cutaneous leishmaniasis patients compared to controls (MD: - 26.65; 95% CI: [- 42.74, - 10.57]; p = 0.001). However, zinc therapy did not demonstrate a significant clinical improvement compared to standard treatment (RR: 0.96; 95% CI: [0.74, 1.23], p = 0.73).

Statistical Analysis of the Risk Factors Associated with Visceral Leishmaniasis Patients at Marsabit County Referral Hospital

Statistical Analysis of the Risk Factors Associated with Visceral Leishmaniasis Patients at Marsabit County Referral Hospital

Investigation of Leishmania RNA Virus 2 in Leishmania major and Leishmania tropica Strains Isolated from Cutaneous Leishmaniasis Patients in Türkiye

Leishmania RNA virus (LRV) is a double-stranded RNA (dsRNA) virus that is thought to contribute to the severe inflammatory response of the causative Leishmania parasite in the mammalian host by being present in many isolates of Leishmania spp. In our study, it was aimed to obtain data on the presence of Leishmania RNA Virus 2 (LRV2), which is thought to cause a change in the clinical course of leishmaniasis, in Leishmania major and Leishmania tropica isolates isolated from cutaneous leishmaniasis (CL) patients in Türkiye. Leishmania strains stored in liquid nitrogen tank by cryopreservation in Manisa Celal Bayar University Faculty of Medicine Parasite Bank were resuscitated under suitable conditions and cultivated in NNN and RPMI-1640 media. Then, the isolates were allowed to enter the logarithmic phase in a 26ºC incubator and DNA isolations were made using the "High Pure PCR Template Preparation Kit". Real-time polymerase chain reaction (Rt-PCR) melting analyzes were applied to the DNAs obtained by using primers and probes specific to the internal transcribed spacer-1 (ITS-1) gene region of Leishmania. After RNA isolation from promastigote suspension, cDNA synthesis was performed by reverse transcription. After gel electrophoresis with PCR amplification products, dsRNA band formation was evaluated in terms of LRV2 positivity under ultraviolet light. Among the 20 examined Leishmania spp. isolates (10 L.tropica and 10 L.major), four (three L.tropica, one L.major) were found to be positive for the presence of LRV2. Although the mechanism of LRV in recent studies has not been fully understood, it is known that it exacerbates the clinic of the disease and even has an effect on the formation of drug resistance by the parasite. It is important to obtain data on the presence of LRV in our country and to contribute to various clinical, drug development, prevalence studies, diagnosis and treatment of the disease in the future.

Cutaneous leishmaniasis in Kutaber District, Ethiopia: Prevalence, sand fly fauna and community knowledge, attitude and practices

BackgroundCutaneous leishmaniasis (CL) affects 25% of the population living in the highlands of Ethiopia. CL intervention has not decreased the number of leishmaniasis patients. A cross-sectional study was conducted to determine CL prevalence, community’s knowledge, attitude and practices (KAP), and the sand fly fauna in Kutaber district, northeast Ethiopia. MethodsA retrospective, community-based cross-sectional study was conducted in Boru Meda Hospital from December 2014–March 2021 to study CL prevalence of Kutaber district. A Pre-tested, well-structured questionnaire was used to collect data on the participants' socio-demographic characteristics, KAP towards CL and knowledge about sand fly vectors. Chi-square test and logistic regression analysis were used in the study, and data were analyzed using SPSS version 23 (p < 0.05). ResultsA total of 10,002 (14.02%), of which 71,325 samples were confirmed as positive for CL. The infection rate of CL in females (7.1%) was a little bit higher than males (7.0%). More cases were recorded among 15–29 age category. The study also revealed that 77.1% of the respondents had poor knowledge about CL treatment, prevention, clinical presentation and disease transmission. Farmers tended to have poorer knowledge about sand flies than non-workers and students (32.7 vs. 35 and 44.1%; P = 0.049). Housewives had poorer knowledge about sand flies than farmers and workers (22.2 vs. 32.7 and 33.3%; P = 0.023). Phlebotomus longipes comprised the highest composition (80%) of the sand fly species identified in Kutaber district. ConclusionsThe data showed that the community had poor knowledge about CL, vector, and transmission mode. CL preventive measures were prevalent, implying the need to raise CL awareness. Phlebotomus longipes was identified as the most dominant sand fly species which accounted for CL. The findings can be used in developing an effective control strategy to reduce CL transmission in the study area and elsewhere in Ethiopia.

Safety and immunogenicity of ChAd63-KH vaccine in post-kala-azar dermal leishmaniasis patients in Sudan (lay summary)

Safety and immunogenicity of ChAd63-KH vaccine in post-kala-azar dermal leishmaniasis patients in Sudan (lay summary)

Therapeutic response and safety of different treatments for cutaneous leishmaniasis in patients: A retrospective cross-sectional study

Objective: To analyze the therapeutic response and safety of different treatments for cutaneous leishmaniasis, received by patients in the Program for the Study and Control of Tropical Diseases- PECET-Medellín-Colombia. Methods: This is a retrospective cross-sectional study of patients attended at PECET Research Center during 2016-2021. Relevant information regarding sociodemographic characteristics, history of leishmaniasis, characterization of current infection, treatment received, follow-up of therapeutic response and safety was collected from the medical records. Data were analyzed with Pearson's Chi-square association tests and Mann-Whitney U test using statistical software. Results: A total of 486 clinical records of patients were analyzed, and 356 received treatment. Eight different therapeutic alternatives (systemic, local and in combination) were analyzed. The therapeutic response of the different alternatives used (except thermotherapy) was higher than 50%. Most frequent adverse events were myalgias, arthralgias and headache, and vesicles for systemic and local treatment, respectively. Conclusions: Safety profile and performance of local therapeutic alternatives and combined schemes for the treatment of uncomplicated cutaneous leishmaniasis are an interesting option for the management of the disease.

Modeling visceral leishmaniasis and tuberculosis co-infection dynamics

The co-infection of visceral leishmaniasis (VL) and tuberculosis (TB) patients pose a major public health challenge. In this study, we develop a mathematical model to study the transmission dynamics of VL and TB co-infection by first analyzing the VL and TB sub-models separately. The dynamics of these sub-models and the full co-infection model are determined based on the reproduction number. When the associated reproduction number (R1) for the TB-only model and (R2) for the VL-only are less than unity, the model exhibits backward bifurcation. If max{R1,R2}=R1, then the TB-VL co-infection model exhibits backward bifurcation for values of R1. Furthermore, if max{R1,R2}=R2, and by choosing the transmission probability, βL as the bifurcation parameter, then the phenomenon of backward bifurcation occurs for values of R2. Consequently, the full model, whose associated reproduction number is R0, also exhibits backward bifurcation when R0=1. The equilibrium points and their stability for the models are determined and analyzed based on the magnitude of the respective reproduction numbers. Finally, some numerical simulations are presented to show the reliability of our theoretical results.

Cytomorphological Variations of Leishman-Donovan Bodies Found in Cutaneous Leishmaniasis Patients in Sri Lanka

Abstract Leishmania parasites undergo a dimorphic life cycle. Diagnosis of cutaneous leishmaniasis (CL) is primarily made by the microscopic identification of the amastigote form of the parasite in a smear. Therefore, correct identification of Leishman-Donovan (LD) bodies in smears is crucial for CL confirmation. The aim of this study was to provide a broad overview of different cytomorphologies of LD bodies to improve the sensitivity of microscopic detection of Leishmania donovani, which causes CL in Sri Lanka. A total of 125 smears, prepared from patients who met the positive diagnostic criteria of CL, were Giemsa stained and examined microscopically. The density, cellular location and all possible cytomorphological forms of the parasite were documented. A total of 10 different cytomorphological forms of LD bodies were identified. Among them, the round form was observed only intracellularly. The other morphological forms, namely the pear shape, cigarette shape, candle flame form, embryo shape, flagellate form, binary form and rosette form, were found only extracellularly. The spindle form and lens shape were observed in both intracellular and extracellular locations. L. donovani amastigotes have a wide range of morphologies besides their classical forms. Although Leishmania are considered as obligatory intracellular parasites, they manage to survive successfully within the extracellular hostile conditions as well. Therefore, having a broader view of different morphological forms for Leishmania parasites may help to improve diagnosis of CL.

The effect of health literacy and other factors on the delays in applying to the health center of cutaneous leishmaniasis patients

Amaç: Çalışma Şanlıurfa’daki Kutanöz leishmaniasis vakalarının başvuru gecikmesini ve Sağlık Okuryazarlığı Değerlendirme Ölçeği puanlarının Kutanöz leishmaniasis hastalarındaki düzeyini değerlendirmek amacıyla yürütülmüştür. Gereç ve Yöntem: Yapılan araştırma kesitsel tipte bir çalışmadır. Çalışmanın bağımlı değişkeni; Kutanöz leishmaniasis tedavisine yönelik başvuru gecikmesidir. Bulgular: Tedavi merkezine başvuru gecikmesi sıklığı %20,0 olarak saptanmıştır. Katılımcıların ölçek puanları ile öğrenim durumları arasında istatistiksel olarak anlamlı ve pozitif yönlü korelasyon saptanmıştır. Sonuç: Hastaların tedavi için başvuru gecikmesi düzeyi yüksektir. Sağlık Okuryazarlığı Değerlendirme Ölçeği, eğitim durumuna paralel olarak sağlık okuryazarlığı düzeyini iyi bir şekilde göstermektedir ve Şanlıurfa bölgesi için sağlık okuryazarlığı düzeyini belirlemede önemli bir araçtır.

Clinicopathological characteristics of cutaneous and mucocutaneous leishmaniasis in patients treated with TNF-α inhibitors.

The increasing use of biologics in the treatment of inflammatory diseases has led to more cases of leishmaniasis in patients subjected to iatrogenic immunosuppression. The main objective was to describe the characteristics of the patients with cutaneous (CL) or mucocutaneous (MCL) leishmaniasis who were receiving a biological therapy at the time of diagnosis. A multicenter retrospective study was design based on a cohort of patients diagnosed with CL or MCL. All patients who were being treated with biologicals were included. For each case, two matched non-exposed patients were included for comparison. 38 patients were diagnosed with CL or MCL while being treated with tumor necrosis factor alpha (TNF-α) inhibitors. Leishmaniasis presented more frequently as a plaque (58.3%) with a larger median lesion size (2.5cm), ulceration (92.1%), and required a greater median number of intralesional meglumine antimoniate infiltrations (3 doses) (P <0.05) than in non-exposed patients. We found no systemic involvement in patients being treated with anti-TNF-α. We did not find differences regarding the treatment characteristics whether biologic therapy was modified or not. Although management should be individualized, maintenance of biologic therapy does not seem to interfere with treatment of CL or MCL.

TLR9 agonist CpG ODN 2395 promotes the immune response against Leishmania donovani in obesity and undernutrition mice

As important immunomodulators, CpG ODNs have broad application prospects in the treatment and prevention of leishmaniasis. In order to explore the immunomodulatory effect of CpG ODNs on mice infected with Leishmania parasites in different nutritional status, TLR9 agonist CpG ODN 2395 or TLR9 antagonist CpG ODN 2088 was injected into normal, obesity and undernutrition BALB/c mice infected with Leishmania donovani, respectively. Subsequently, spleen and liver parasite loads, spleen and liver immune gene expression, spleen T cell subsets proportion and PD-1 expression, serum lipids, serum cytokines, and anti-Leishmania antibodies were measured to assess the immune response of mice with different nutritional status. The results displayed that at the 8th week after infection, the spleen parasite load of obesity and undernutrition mice was significantly higher than that of normal mice, but the liver parasite load showed no statistical difference among the three groups. The treatment of CpG ODN 2395 or CpG ODN 2088 significantly reduced the spleen parasite load of obesity and undernutrition infected mice, but did not reduce that of normal infected mice. In obesity infected mice, CpG ODN 2395 promoted the up-regulation of TCR, ICOS and TLR4 in spleen, promoted the secretion of IFN-γ and anti-Leishmania total IgG and IgG1 antibodies, and increased the content of serum HDL-C. In undernutrition infected mice, CpG ODN 2395 promoted the up-regulation of spleen CD28 and TLR9, increased the proportion of spleen CD3+ T cells, and decreased the content of serum IL-10. Our results demonstrated that CpG ODN 2395 enhanced the immune response and clearance of Leishmania parasites in obesity and undernutrition mice, which might be used as a therapeutic agent for obesity and undernutrition leishmaniasis patients in the future.

Adenosine Deaminase values of serum and erythrocytes in patients with Cutaneous Leishmaniasis and healthy subjects in Nineveh state population

Cross sectional, hospital based study was carried out on 46 Cutaneous Leishmaniasis patients (25 males and 21 females) and fifty four healthy volunteers were investigated to serve as normal subjects. Serum and erythrocytes Adenosine Deaminase activity was assessed spectrophotometerically by using colorimetric method. Serum and erythrocytes Adenosine Deaminase activity of Leishmaniasis-patienats were highly significant (p&lt; 0.005) and higher (38.8 ± 2.5 and 188.1 ± 23.3 U/L) than that values of healthy individuals ( 14.8 ± 1.4 and 64.1 ± 7.5 U/L respectively). No significant difference values were found in blood ADA activity according age and sex. In conclusion serum and erythrocytes ADA values may be used in the follow up of patients with Cutaneous Leishmaniasis together with clinical and other laboratory findings.

Transcriptome Analysis of Dermal Fibroblasts Derived From Visceral Leishmaniasis and Post-Kala-Azar Dermal Leishmaniasis Patients Reveal Disease-Specific Gene Expression and Pathological Regulation.

Post-kala-azar dermal leishmaniasis (PKDL), a dermal form of the disease, occurs in some visceral leishmaniasis (VL) patients following treatment. The PKDL disease mechanism is not yet clearly understood. Here we have studied the role of dermal fibroblasts in VL and PKDL disease mechanism. Dermal fibroblasts were grown from skin biopsy explants collected from individual VL and PKDL patients and healthy controls. Fibroblasts from the third passage were subjected to RNA sequencing to analyze differentially expressed genes (DEGs). Significantly important genes were further validated by reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). Transcriptome analysis of PKDL versus VL identified 516 DEGs (263 were overrepresented and 253 were underrepresented in PKDL). Among the top hub genes, MMP2, IL1B, CXCL8, IFIH1, NFKB1A, IL6, ISG15, and EGFR were underexpressed and ACTB, HSP90AA1, RAB7A, and RPS27A were overexpressed in PKDL compared to VL. Our data indicate that PKDL fibroblasts may present antigens through the MHC I pathway activating CD8+ T-cell mediated response, while VL fibroblasts express nuclear factor-κB (NFκB)-mediated chemokines, IL1B, IL6, and IL8, resulting in the recruitment of natural killer (NK)-cells and monocytes to the site of infection, leading to the clearance of parasite from the skin and visceralization of the disease.

Comparing Dermatoscopic Features With Slit Skin Smear and Histopathology in Diagnosis of Cutaneous Leishmaniasis.

To evaluate dermatoscopic features of cutaneous leishmaniasis and to compare its diagnostic accuracy against slit skin smear and skin histopathology. This cross-sectional study was conducted at the Department of Dermatology, Pakistan Navy Station (PNS) Shifa Hospital, Karachi, Pakistan, from August 2021 to August 2022. A total of 200 lesions from 70 patients of cutaneous leishmaniasis diagnosed with slit skin smear for Leishmania-Donovan (LD) bodies and skin biopsy were included via non-probability consecutive sampling technique. Dermatoscopic evaluation was performed via a handheld dermatoscope (DELTA 20T; HEINE,Gilching, Germany) on 10x magnification. All dermatoscopic images were analyzed by two different observers who had command of dermatoscopy. Data analysis was done using Statistical Package for the Social Sciences SPSS version 27 (IBM Corp., Armonk, NY, USA). Common dermatoscopic findings were erythema 200 (100%), hyperkeratosis 140 (70%), crusting 50 (25%), ulceration 42 (21%), milia-like structure 58 (29%), tear drop-like structure 46 (23%), yellow tears 70 (35%), and white starburst pattern 68 (34%). Less common findings were yellow hue 28 (14%), orange areas 26 (13%) and scar seven (3.5%). Vascular structures frequently observed were linear vessels 109 (54.5%), dotted vessels 80 (40%), and hairpin vessels 61 (30.5%); less common findings were comma-shaped vessels 52 (26%), arborizing vessels 20 (10%), crown vessels nine (4.5%). Comparison of dermatoscopic features was done with slit skin smear for LD bodies (p value = 0.003 ) and histopathology (p value = 0.001). Dermatoscopy is a non-invasive technique that is helpful in diagnosing cutaneous leishmaniasis, saving time in making rapid diagnosis and saving the need to undergo extensive invasive investigation. Yield of dermatoscopy was comparable to slit smear for LD bodies and histopathology and was found to be effective in making rapid diagnosis with significant accuracy (p value <0.05).

Proinflammatory cytokines (TNF-a, IL-1B, IL-6) and antioxidant in different stages of patients with cutaneous Leishmaniasis

Introduction: Leishmania is a significant health problem in many parts of world. TNF-α is an essential player in infections with leishmania major, contributing to the control of the inflammatory lesion, a lesser degree and parasite killing. Inflammatory molecules (TNF-a, IL-1B and IL-6) were probably responsible for the stronger cellular recruitment and mainly seen at the site of infections. The aim of this study was evaluated of pro inflammatory cytokines and (antioxidant) in four groups of cutaneous leishmaniasis patients compared with together and normal group. These cytokines measured in 39 patients were divided into four groups of: 1) active (acute phase of treatment); 2) non-healing (received treatment for almost two years without recovery);3) healing (recovered upon treatment); and 4) healed (treatment previously received and achieved complete remission). Pro inflammatory cytokines and antioxidant about 3 of these patients from active stage to heal were specifically evaluated also. Material &amp; Methods: IL-1β, TNFα, IL-6 in serum of patients measured by ELISA and antioxidant determined by FRAP method. Results: Antioxidant mostly decreased in groups near to normal group, but increased in non -healing group. The serum level of pro inflammatory cytokines: TNFα, increased in three groups of patients compared to normal group. Highest level of IL-1β belong to non- healing average, whether, others and normal group had zero value of IL-1β. IL-6 had highest level in non- healing, but had not significant difference in other groups. In three of these active patients which leading to health, TNFα, IL6&amp; IL1β strongly decreased. Discussion: This Study suggestion, there is direct correlation between of pro inflammatory cytokines (IL-1B, TNF α, IL-6) and progressive of disease. Another finding shows that antioxidant level had extremely strong correlation with progresses response to drug and lead to healthy of disease

Epidemiological, clinical and hematological profiles of visceral leishmaniasis among patients visiting Tefera Hailu Memorial Hospital, Northeast Ethiopia: a 4 year retrospective study

Visceral leishmaniasis is a major, life-threatening parasitic disease that still remains a serious public health problem in Ethiopia. Understanding the epidemiological, clinical, and hematological profiles of visceral leishmaniasis patients is important for implementing evidence-based control strategies. It is also important for early treatment and to decrease the mortality rate from the disease. Therefore, this study was aimed at assessing the epidemiological, clinical, and hematological profiles of visceral leishmaniasis among patients visiting Tefera Hailu Memorial Hospital, Northeast Ethiopia. A retrospective study was conducted at Tefera Hailu Memorial Hospital from September 2017 to August 2021. Data were collected from the medical records of suspected patients who were tested by the rK39 rapid diagnostic by strictly following standard operating procedures. The data was summarized using Microsoft Excel and analyzed using SPSS 26 version software. Descriptive statistics were used to describe the epidemiological, clinical, and hematological profiles of visceral leishmaniasis patients. A p-value < 0.05 was considered statistically significant. The overall positivity rate for visceral leishmaniasis was 23.4% (132/564). The result of this study indicated a fluctuating yet declining trend in VL over the past 4 years. From a total of 132 VL confirmed cases, the numbers of cases were highest among males (78.0%), those 15–29 years of age (37.1%), and urban residents (89.4%). Furthermore, Abergele (11.0%), Sehala (6.0%), and Ziquala (5.0%) districts had the highest number of VL cases. The major clinical presentations of patients were fever (96.2%), splenomegaly (94.7%), and general weakness (80.3%). With regard to hematological profiles, the most common findings were anemia (86.4%), thrombocytopenia (81.8%), leucopenia (78.8%), neutropenia (74.2%), and pancytopenia (71.2%). In the study area, the VL positivity rate was high. Our findings also concluded that VL causes significant alterations in clinical and hematological parameters. Therefore, the zone health office and other concerned stakeholders should strengthen evidence-based control programs for VL.

Hematological and Clinical Features Associated with Initial Poor Treatment Outcomes in Visceral Leishmaniasis Patients with and without HIV Coinfection in Gondar, Northwest Ethiopia.

Ethiopia is among the countries with a high leishmaniasis burden. In this retrospective review, we aimed to determine hematological and clinical features associated with initial poor treatment outcomes of visceral leishmaniasis (VL) patients. The majority of VL cases in this study had leucopenia (94.3%), thrombocytopenia (87.1%), and anemia (85.9%). HIV coinfection was present in 7.0% (n = 23) of VL cases. At the center, VL patients without HIV coinfection were treated with sodium stibogluconate and paromomycin combination, whereas HIV coinfected cases were treated with AmBisome and miltefosine combination therapy. End-of-treatment cure rates among HIV-positive and HIV-negative visceral leishmaniasis cases, respectively, were 52.2% and 96.9%. Case fatality rates were 34.8% and 2.7% in HIV-positive and HIV-negative cases, respectively. Overall, non-survivors in this study were more likely to have HIV (55.0% vs. 4.1%, p < 0.001), sepsis (15.0% vs. 1.4%, p = 0.019), and dyspnea (40.0% vs. 2.7%, p < 0.001) at admission. In this regard, particular attention to the management of superimposed disease conditions at admission, including sepsis, HIV, and dyspnea, is needed to improve VL patients’ treatment outcomes. The inadequacy of the current treatments, i.e., AmBisome and miltefosine combination therapy, for HIV coinfected visceral leishmaniasis patients requires further attention as it calls for new treatment modalities.