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- Title
Premature deaths by visceral leishmaniasis in Brazil investigated through a cohort study: A challenging opportunity?
- Authors
Maia-Elkhoury, Ana Nilce S.; Sierra Romero, Gustavo Adolfo; O. B. Valadas, Samantha Y.; L. Sousa-Gomes, Marcia; Lauletta Lindoso, José Angelo; Cupolillo, Elisa; Ruiz-Postigo, Jose Antonio; Argaw, Daniel; Sanchez-Vazquez, Manuel J.
- Abstract
Background: Visceral Leishmaniasis (VL) is the most severe form of leishmaniasis because it can lead to death. In the Americas, 96% of cases are in Brazil, and despite efforts, the fatality rate has increased in the past years. We analyzed deaths associated to VL in Brazil and investigated the factors that could influence on the timeliness of fatal outcome with emphasis on time (tStoD). Methodology: The registered deaths by VL were sourced from the Brazilian National Notification System from 2007–2014. Through a retrospective cohort study, univariate and multivariable Cox proportional hazards model analysis were performed and investigated the factors that could influence the time (tStoD). These factors were analyzed through survival models. Results: Out of the 1,589 reported deaths, the median for onset of the symptoms and the case notification date (tStoN) is 25 days (10–61), and for date of case notification and death (tNotD) is 9 days (4–17). The time (tStoN) to event investigation for HIV non-infected individuals was 1.4 (1.16–1.68) greater than the HIV positive group. At the same time peri-urban and urban area were 0.83 (0.47–1.44) and 1.33 (1.16–1.52), respectively. The explorations revealed apparent differences between the time to event investigation (both for tStoN and tNotD) and the age at the onset of the symptoms. According to the tStoN the rate of notification is 1.73 times greater in patients under 5 years old at the onset of the clinical symptoms compared to older patients. Conclusion: VL patients under 5 years old were diagnosed earlier and had shorter survival. It could mean that in younger population, although properly diagnosed, the fatality pattern might be related to the severity of the disease. Main host characteristics were evaluated, and age and co-infections seem to have an impact in the disease progression. Author summary: Visceral Leishmaniasis (VL) is present worldwide, affecting mainly economically vulnerable populations in over 80 countries. In the Americas, Brazil accounts for approximately 96% of the cases. VL as one of the most relevant endemic neglected diseases in the world, due to its incidence and high fatality, which is generally reported among untreated individuals, and its emerging pattern in human immunodeficiency virus (HIV) infected individuals. Despite the increasing knowledge on prognostic factors, incorporation of new diagnostic tools and increasing access to new treatments, case fatality rate remains high in Brazil. The analysis revealed differences in the time to event investigation according to HIV status, being greater for HIV infected individuals, particularly for the period between case notification and death. The time between onset of the symptoms and case notification appears to be greater in peri-urban and rural areas compared to the urban areas. Also, differences in the time to event investigation according to patient's age at the onset of symptoms was evident, being longer for 5 years old or older patients. Our findings identified that children under 5 years old are at higher risk of premature death being relevant for planning interventions aimed at reduction of VL lethality in Brazil.
- Subjects
BRAZIL; VISCERAL leishmaniasis; EARLY death; PROPORTIONAL hazards models; ENDEMIC diseases; COHORT analysis
- Publication
PLoS Neglected Tropical Diseases, 2019, Vol 13, Issue 12, pN.PAG
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0007841