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Epidemiological changes in leishmaniasis in Spain according to hospitalization-based records, 1997-2011: raising awareness towards leishmaniasis in non-HIV patients.

Herrador Z, Gherasim A, Jimenez BC, Granados M, San Martín JV, Aparicio P - PLoS Negl Trop Dis (2015)

Bottom Line: Leishmaniasis-HIV co-infection was significantly associated with male sex (aOR=1.6; 95% CI: 1.25-2.04), 16-64 years age group (aOR=17.4; 95%CI: 2.1-143.3), visceral leishmaniasis aOR=6.1 (95%CI: 3.27-11.28) and solid neoplasms 4.5 (95% CI: 1.65-12.04).The absence of HIV co-infection was associated with lymph/hematopoietic neoplasms (aOR=0.3; 95%CI:0.14-0.57), other immunodeficiency (aOR=0.04; 95% CI:0.01-0.32) and transplant (aOR=0.01; 95%CI:0.00-0.07).Our findings suggest a significant increase of hospitalization in the absence of HIV co-infection, with a predomination of VL.

View Article: PubMed Central - PubMed

Affiliation: National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain; Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.

ABSTRACT
In Spain, Leishmania infantum is endemic, human visceral and cutaneous leishmaniasis cases occurring both in the Peninsula, as well as in the Balearic Islands. We aimed to describe the clinical characteristics of leishmaniasis patients and the changes in the disease evolution after the introduction of antiretroviral therapy in 1997. In this descriptive study, we used Spanish Centralized Hospital Discharge Database for the hospitalized leishmaniasis cases between 1997 and 2011. We included in the analysis only the records having leishmaniasis as the first registered diagnosis and calculated the hospitalization rates. Disease trend was described taking into account the HIV status. Adjusted odds-ratio was used to estimate the association between clinical and socio-demographic factors and HIV co-infection. Of the total 8010 Leishmaniasis hospitalizations records, 3442 had leishmaniasis as first diagnosis; 2545/3442 (75.6%) were males and 2240/3442 (65.1%) aged between 14-65 years. Regarding disease forms, 2844/3442 (82.6%) of hospitalizations were due to visceral leishmaniasis (VL), while 118/3442 (3.4%) hospitalizations were cutaneous leishmaniasis (CL). Overall, 1737/2844 of VL (61.1%) were HIV negatives. An overall increasing trend was observed for the records with leishmaniasis as first diagnosis (p=0.113). Non-HIV leishmaniasis increased during this time period (p=0.021) while leishmaniasis-HIV co-infection hospitalization revealed a slight descending trend (p=0.717). Leishmaniasis-HIV co-infection was significantly associated with male sex (aOR=1.6; 95% CI: 1.25-2.04), 16-64 years age group (aOR=17.4; 95%CI: 2.1-143.3), visceral leishmaniasis aOR=6.1 (95%CI: 3.27-11.28) and solid neoplasms 4.5 (95% CI: 1.65-12.04). The absence of HIV co-infection was associated with lymph/hematopoietic neoplasms (aOR=0.3; 95%CI:0.14-0.57), other immunodeficiency (aOR=0.04; 95% CI:0.01-0.32) and transplant (aOR=0.01; 95%CI:0.00-0.07). Our findings suggest a significant increase of hospitalization in the absence of HIV co-infection, with a predomination of VL. We consider that clinicians in Spain should be aware of leishmaniasis not only in the HIV population but also in non HIV patients, especially for those having immunosuppression as an associate condition.

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Median rates of hospitalizations with leishmaniasis as first diagnosis for HIV and non HIV leishmaniasis by autonomous community, Spain, 1997–2011.
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pntd.0003594.g002: Median rates of hospitalizations with leishmaniasis as first diagnosis for HIV and non HIV leishmaniasis by autonomous community, Spain, 1997–2011.

Mentions: Regarding the distribution of leishmaniasis hospitalizations (as first diagnosis) throughout the whole study period, the Madrid region had the highest median hospitalization rate (10.3 hospitalizations/1 million population), followed by the Balearic Islands (7.2/1 million population), Valencia (7.4/1 million population), Aragon (6.8/1 million population) and Castilla La Mancha (6.4/1 million population). The Northern autonomous communities of Spain (Cantabria, Navarra, Basque Country and Galicia) were among the ones with lower leishmaniasis hospitalization rates (S1 Table). The highest differences between leishmaniasis alone and leishmaniasis-HIV co-infection were registered in Castilla La Mancha, Catalonia and Murcia. Interestingly, Aragon was the only region where leishmaniasis-HIV co-infection hospitalization rate was higher than leishmaniasis alone (Fig. 2).


Epidemiological changes in leishmaniasis in Spain according to hospitalization-based records, 1997-2011: raising awareness towards leishmaniasis in non-HIV patients.

Herrador Z, Gherasim A, Jimenez BC, Granados M, San Martín JV, Aparicio P - PLoS Negl Trop Dis (2015)

Median rates of hospitalizations with leishmaniasis as first diagnosis for HIV and non HIV leishmaniasis by autonomous community, Spain, 1997–2011.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4355586&req=5

pntd.0003594.g002: Median rates of hospitalizations with leishmaniasis as first diagnosis for HIV and non HIV leishmaniasis by autonomous community, Spain, 1997–2011.
Mentions: Regarding the distribution of leishmaniasis hospitalizations (as first diagnosis) throughout the whole study period, the Madrid region had the highest median hospitalization rate (10.3 hospitalizations/1 million population), followed by the Balearic Islands (7.2/1 million population), Valencia (7.4/1 million population), Aragon (6.8/1 million population) and Castilla La Mancha (6.4/1 million population). The Northern autonomous communities of Spain (Cantabria, Navarra, Basque Country and Galicia) were among the ones with lower leishmaniasis hospitalization rates (S1 Table). The highest differences between leishmaniasis alone and leishmaniasis-HIV co-infection were registered in Castilla La Mancha, Catalonia and Murcia. Interestingly, Aragon was the only region where leishmaniasis-HIV co-infection hospitalization rate was higher than leishmaniasis alone (Fig. 2).

Bottom Line: Leishmaniasis-HIV co-infection was significantly associated with male sex (aOR=1.6; 95% CI: 1.25-2.04), 16-64 years age group (aOR=17.4; 95%CI: 2.1-143.3), visceral leishmaniasis aOR=6.1 (95%CI: 3.27-11.28) and solid neoplasms 4.5 (95% CI: 1.65-12.04).The absence of HIV co-infection was associated with lymph/hematopoietic neoplasms (aOR=0.3; 95%CI:0.14-0.57), other immunodeficiency (aOR=0.04; 95% CI:0.01-0.32) and transplant (aOR=0.01; 95%CI:0.00-0.07).Our findings suggest a significant increase of hospitalization in the absence of HIV co-infection, with a predomination of VL.

View Article: PubMed Central - PubMed

Affiliation: National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain; Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.

ABSTRACT
In Spain, Leishmania infantum is endemic, human visceral and cutaneous leishmaniasis cases occurring both in the Peninsula, as well as in the Balearic Islands. We aimed to describe the clinical characteristics of leishmaniasis patients and the changes in the disease evolution after the introduction of antiretroviral therapy in 1997. In this descriptive study, we used Spanish Centralized Hospital Discharge Database for the hospitalized leishmaniasis cases between 1997 and 2011. We included in the analysis only the records having leishmaniasis as the first registered diagnosis and calculated the hospitalization rates. Disease trend was described taking into account the HIV status. Adjusted odds-ratio was used to estimate the association between clinical and socio-demographic factors and HIV co-infection. Of the total 8010 Leishmaniasis hospitalizations records, 3442 had leishmaniasis as first diagnosis; 2545/3442 (75.6%) were males and 2240/3442 (65.1%) aged between 14-65 years. Regarding disease forms, 2844/3442 (82.6%) of hospitalizations were due to visceral leishmaniasis (VL), while 118/3442 (3.4%) hospitalizations were cutaneous leishmaniasis (CL). Overall, 1737/2844 of VL (61.1%) were HIV negatives. An overall increasing trend was observed for the records with leishmaniasis as first diagnosis (p=0.113). Non-HIV leishmaniasis increased during this time period (p=0.021) while leishmaniasis-HIV co-infection hospitalization revealed a slight descending trend (p=0.717). Leishmaniasis-HIV co-infection was significantly associated with male sex (aOR=1.6; 95% CI: 1.25-2.04), 16-64 years age group (aOR=17.4; 95%CI: 2.1-143.3), visceral leishmaniasis aOR=6.1 (95%CI: 3.27-11.28) and solid neoplasms 4.5 (95% CI: 1.65-12.04). The absence of HIV co-infection was associated with lymph/hematopoietic neoplasms (aOR=0.3; 95%CI:0.14-0.57), other immunodeficiency (aOR=0.04; 95% CI:0.01-0.32) and transplant (aOR=0.01; 95%CI:0.00-0.07). Our findings suggest a significant increase of hospitalization in the absence of HIV co-infection, with a predomination of VL. We consider that clinicians in Spain should be aware of leishmaniasis not only in the HIV population but also in non HIV patients, especially for those having immunosuppression as an associate condition.

Show MeSH
Related in: MedlinePlus