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Splenectomy in Patients with Visceral Leishmaniasis Resistant to Conventional Therapy and Secondary Prophylaxis: A Retrospective Cohort

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  • 1 University Hospital of the Federal University of Piauí, Teresina, Brazil;
  • | 2 Hospital Getúlio Vargas, Teresina, Brazil;
  • | 3 Department of Specialized Medicine, Federal University of Piauí, Teresina, Brazil;
  • | 4 Department of Community Medicine, Federal University of Piauí, Teresina, Brazil;
  • | 5 Oswaldo Cruz Foundation, Gonçalo Moniz Institute, Salvador, Brazil;
  • | 6 Maternal and Child Department, Federal University of Piauí, Teresina, Brazil;
  • | 7 Center for Intelligence on Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil;
  • | 8 Fundação Municipal de Saúde of Teresina;
  • | 9 Tropical Diseases Institute “Natan Portella”, Teresina, Brazil;
  • | 10 Department of Microbiology-Infectious Disease and Immunology, Faculty of Medicine, University Laval, Québec, Canada
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ABSTRACT.

Some patients with visceral leishmaniasis (VL), or kala-azar, suffer relapses and low quality of life despite adequate drug therapy, especially those co-infected with HIV. Occasionally, physicians indicate splenectomy, but the benefit of the procedure needs to be analyzed systematically. Therefore, a retrospective open cohort study was conducted in Teresina, Brazil. Inpatients from a reference hospital with relapsing VL who had a rescue splenectomy between 2012 and 2019 after the nationally recommended drug therapy failed were studied. The procedure’s risks and benefits were assessed in a limited-resource setting. The primary outcomes were surgical complications, complete blood count, CD4+ cell count, hospitalizations, survival time, and medical complications preceding death. Thirteen adult patients received medical and surgical indications of splenectomy (12 men and one woman). Eleven had HIV infection. Two had early and two had late complications. Four died, all of whom were infected with HIV. An additional HIV-coinfected patient, apart from the cohort, died just before surgery. The death rate after surgery was 13.3 overall and 22.1 per 100 person-years among HIV-infected patients (31% overall and 36%, respectively). The impressive rise of complete blood counts and reduction of blood transfusions and hospitalizations were observed among all patients. Also, a meaningful increase in CD4+ cells in HIV-infected patients was noted. Splenectomy may benefit patients with relapsing VL. However, before performing splenectomy, available combined drug therapy for VL should be tried.

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Author Notes

Address correspondence to Carlos H. N. Costa, Department of Community Medicine, Federal University of Piauí, Institute for Tropical Diseases “Natan Portella” and Center for Intelligence on Emerging and Neglected Tropical Diseases, Rua Artur de Vasconcelos 160-Sul, 64.001-450, Teresina, Brazil. E-mail: chncosta@gmail.com

Financial support: This work was partially supported by the National Council for Scientific and Technological Development—CNPq. [302571/2015-9 to CHNC and 126588/2014-7 to AJM].

Authors’ addresses: Luis G. C. Reinaldo, University Hospital of the Federal University of Piauí, Teresina, Brazil, and Hospital Getúlio Vargas, Campus da Ininga, Teresina, Brazil, E-mail: lgreinaldo@yahoo.com.br. Raimundo J. C. Araújo-Júnior, University Hospital of the Federal University of Piauí, Department of General Medicine, Federal University of Piauí, Campus da Ininga, CEP 64.049-550, Teresina PI, Brazil, and Hospital Getúlio Vargas, Teresina, Brazil, E-mail: rjuniorcirurgia@ufpi.edu.br. Thiago M. Diniz and Caio V. V. M. Furtado, University Hospital of the Federal University of Piauí, Teresina, Brazil, E-mails: thiagomdiniz@hotmail.com and caiovercoza@gmail.com. Rafael D. Moura, University Hospital of the Federal University of Piauí, Department of Specialized Medicine, Federal University of Piauí, Teresina, Brazil, E-mail: dedeusmoura@gmail.com. Antônio J. Meneses-Filho, LabLeish, Federal University of Piauí, Teresina, Brazil, E-mail: ajfilho87@gmail.com. Washington L. C. Santos, Oswaldo Cruz Foundation, Gonçalo Moniz Institute, Salvador, Brazil, E-mail: wlcdossantos@gmail.com. Dorcas L. Costa, Maternal and Child Department, Federal University of Piauí, Tropical Diseases Institute “Natan Portella” and Center for Intelligence on Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil, E-mail: dorcas.lc@gmail.com. Kelsen D. Eulálio, Instituto de Doenças Tropicais Natan Portella and Municipal Health Foundation of Teresina, Teresina, Brazil, E-mail: kelsendeulalio@yahoo.com.br. Gabriel R. Ferreira, Department of Microbiology-Infectious Disease and Immunology, Faculty of Medicine, University Laval, Québec, Canada, E-mail: ferreira.rgabriel@gmail.com. Carlos H. N. Costa, Department of Community Medicine, Federal University of Piauí, Institute for Tropical Diseases “Natan Portella” and Center for Intelligence on Emerging and Neglected Tropical Diseases, Teresina, Brazil, E-mail: chncosta@gmail.com.

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