ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Desjeux P , Alvar J , 2003. Leishmania/HIV co-infections: epidemiology in Europe. Ann Trop Med Parasitol 97: 3–15.
-
2.
Alvar J et al.2008. The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev 21: 334–359.
-
3.
Olivier M , Badaró R , Medrano FJ , Moreno J , 2003. The pathogenesis of Leishmania/HIV co-infection: cellular and immunological mechanisms. Ann Trop Med Parasitol 97: 79–98.
-
4.
Wolday D , Akuffo H , Demissie A , Britton S , 1999. Role of Leishmania donovani and its lipophosphoglycan in CD4+ T-cell activation-induced human immunodeficiency virus replication. Infect Immun 67: 5258–5264.
-
5.
van Griensven J , Carrillo E , López-Vélez R , Lynen L , Moreno J , 2014. Leishmaniasis in immunosuppressed individuals. Clin Microbiol Infect 20: 286–299.
-
6.
Troya J , Casquero A , Muñiz G , Fern’ndez-Guerrero ML , Górgolas M , 2006. The role of splenectomy in HIV-infected patients with relapsing visceral leishmaniasis. Parasitology 134: 621–624.
-
7.
Bryan P , 1952. Splenectomy in a case of kala-azar; comments on a case. Rev Esp Pediatr 8: 95–99.
-
8.
Das A , Sen Gupta PC , 1950. Relapse of kala-azar after splenectomy. Lancet 256: 681–683.
-
9.
Lyngdoh E , Jain SC , Barua P , 1971. Splenectomy in treatment of drug resistant kala-azar. J Indian Med Assoc 57: 458–461.
-
10.
Dutra RA , Dutra LF , Reis M de O , Lambert RC , 2012. Splenectomy in a patient with treatment-resistant visceral leishmaniasis: a case report. Rev Soc Bras Med Trop 45: 130–131.
-
11.
Alon D , Chowers M , 2012. Successful therapeutic splenectomy in an HIV patient with relapsing visceral leishmaniasis. Int J STD AIDS 23: 289–290.
-
12.
Berman J , 2003. Current treatment approaches to leishmaniasis. Curr Opin Infect Dis 16: 397–401.
-
13.
Tsoukas CM , 1998. Effect of splenectomy on slowing human immunodeficiency virus disease progression. Arch Surg 133: 25–31.
-
14.
Brasil Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância Epidemiológica , 2011 . Manual de Recomendações Para Diagnóstico, Tratamento e Acompanhamento de Pacientes Com a Coinfecção Leishmania-HIV. Normas e Manuais Técnicos.
-
15.
Brasil Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância Das Doenças Transmissívei , 2015 . Manual of Recommendations for Diagnosis, Treatment and Follow-up of Patients with Leishmaniasis–HIV Coinfection.
-
16.
Brasil Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância Epidemiológica, 2014 . Manual de Vigilância e Controle da Leishmaniose Visceral.
-
17.
Li R , Duffee D , Gbadamosi-Akindele MF , 2021. CD4 Count. In: StatPearls. Treasure Island, FL: StatPearls Publishing.
-
18.
Pizzuto J , Ambriz R , 1984. Therapeutic experience on 934 adults with idiopathic thrombocytopenic purpura: multicentric trial of the Cooperative Latin American Group on Hemostasis and Thrombosis. Blood 64: 1179–1183.
-
19.
Katkhouda N , Hurwitz MB , Rivera RT , Chandra M , Waldrep DJ , Gugenheim J , Mouiel J , 1998. Laparoscopic splenectomy. Ann Surg 228: 568–578.
-
20.
Lozano-Salazar RR , Herrera MF , Vargas-Vorácková F , López-Karpovitch X , 1998. Laparoscopic versus open splenectomy for immune thrombocytopenic purpura. Am J Surg 176: 366–369.
-
21.
Rosen M , Brody F , Walsh RM , Tarnoff M , Malm J , Ponsky J , 2002. Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc 16: 272–279.
-
22.
Sarangi J , Coleby M , Trivella M , Reilly S , 1997. Prevention of post splenectomy sepsis: a population based approach. J Public Health (Oxf) 19: 208–212.
-
23.
Crary SE , Buchanan GR , 2009. Vascular complications after splenectomy for hematologic disorders. Blood 114: 2861–2868.
-
24.
Zijlstra EE , 2016. The immunology of post-kala-azar dermal leishmaniasis (PKDL). Parasit Vectors 9: 464.
-
25.
Singh N , Ramesh V , Arora VK , Bhatia A , Kubba A , Ramam M , 1998. Nodular post-kala-azar dermal leishmaniasis: a distinct histopathological entity. J Cutan Pathol 25: 95–99.
-
26.
Reinaldo LGC , Araújo RJC Jr. , Diniz TM , de Deus Moura R , Costa DL , Eulálio KD , Costa CHN , 2020. Recurrent kala-azar: report of two cured cases after total splenectomy. Rev Inst Med Trop Sao Paulo 62: e31.
-
27.
Leite de Sousa-Gomes M , Romero GAS , Werneck GL , 2017. Visceral leishmaniasis and HIV/AIDS in Brazil: are we aware enough? PLoS Negl Trop Dis 11: e0005772.
-
28.
Akuffo H , Costa C , van Griensven J , Burza S , Moreno J , Herrero M , 2018. New insights into leishmaniasis in the immunosuppressed. PLoS Negl Trop Dis 12: e0006375.
-
29.
Feldman LS , Demyttenaere SV , Polyhronopoulos GN , Fried GM , 2008. Refining the selection criteria for laparoscopic versus open splenectomy for splenomegaly. J Laparoendosc Adv Surg Tech A 18: 13–19.
-
30.
Qu Y , Xu J , Jiao C , Cheng Z , Ren S , 2014. Long-term outcomes of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura. Int Surg 99: 286–290.
-
31.
Singer DB , 1973. Postsplenectomy sepsis. Perspect Pediatr Pathol 1: 285–311.
-
32.
Styrt BA , 1996. Risks of infection and protective strategies for the asplenic patient. Infect Dis Clin Pract 5: 94–100.
-
33.
Hansen K , Singer DB , 2001. Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited. Pediatr Dev Pathol 4: 105–121.
-
34.
Lynch AM , Kapila R , 1996. Overwhelming postsplenectomy infection. Infect Dis Clin North Am 10: 693–707.
-
35.
Cunha BA , 1998. Infections in nonleukopenic compromised hosts (diabetes mellitus, SLE, steroids, and asplenia) in critical care. Crit Care Clin 14: 263–282.
-
36.
Marques RG , Petroianu A , 2003. Infecção fulminante pós-esplenectomia. Arq Gastroenterol 40: 47–54.
-
37.
Droz N , Hsia Y , Ellis S , Dramowski A , Sharland M , Basmaci R , 2019. Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries: a systematic review and meta-analysis. Antimicrob Resist Infect Control 8: 207.
-
38.
Long B , Koyfman A , Gottlieb M , 2021. Complications in the adult asplenic patient: a review for the emergency clinician. Am J Emerg Med 44: 452–457
-
39.
Lima IP , Müller MC , Holanda TA , Harhay M , Costa CHN , Costa DL , 2013. Human immunodeficiency virus/Leishmania infantum in the first foci of urban American visceral leishmaniasis: clinical presentation from 1994 to 2010. Rev Soc Bras Med Trop 46: 156–160.
-
40.
Lindoso JAL , Moreira CHV , Cunha MA , Queiroz IT , 2018. Visceral leishmaniasis and HIV coinfection: current perspectives. HIV AIDS (Auckl) 10: 193–201
-
41.
Vechi HT , de Sousa ASV , da Cunha MA , Shaw JJ , Luz KG , 2020. Case report: combination therapy with liposomal amphotericin B, N-methyl neglumine antimoniate, and pentamidine isethionate for disseminated visceral leishmaniasis in a splenectomized adult patient. Am J Trop Med Hyg 102: 268–273.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1767 | 700 | 92 |
| Full Text Views | 177 | 63 | 0 |
| PDF Downloads | 140 | 20 | 0 |
Splenectomy in Patients with Visceral Leishmaniasis Resistant to Conventional Therapy and Secondary Prophylaxis: A Retrospective Cohort
Luis G. C. Reinaldo
Luis G. C. Reinaldo
University Hospital of the Federal University of Piauí, Teresina, Brazil;
Hospital Getúlio Vargas, Teresina, Brazil;
Search for other papers by Luis G. C. Reinaldo in
Current site
Google Scholar
PubMed
Hospital Getúlio Vargas, Teresina, Brazil;
Search for other papers by Luis G. C. Reinaldo in
Current site
Google Scholar
PubMed
Raimundo J. C. Araújo-Júnior
Raimundo J. C. Araújo-Júnior
University Hospital of the Federal University of Piauí, Teresina, Brazil;
Hospital Getúlio Vargas, Teresina, Brazil;
Department of Specialized Medicine, Federal University of Piauí, Teresina, Brazil;
Search for other papers by Raimundo J. C. Araújo-Júnior in
Current site
Google Scholar
PubMed
Hospital Getúlio Vargas, Teresina, Brazil;
Department of Specialized Medicine, Federal University of Piauí, Teresina, Brazil;
Search for other papers by Raimundo J. C. Araújo-Júnior in
Current site
Google Scholar
PubMed
Thiago M. Diniz
Thiago M. Diniz
University Hospital of the Federal University of Piauí, Teresina, Brazil;
Search for other papers by Thiago M. Diniz in
Current site
Google Scholar
PubMed
Search for other papers by Thiago M. Diniz in
Current site
Google Scholar
PubMed
Rafael D. Moura
Rafael D. Moura
University Hospital of the Federal University of Piauí, Teresina, Brazil;
Department of Specialized Medicine, Federal University of Piauí, Teresina, Brazil;
Search for other papers by Rafael D. Moura in
Current site
Google Scholar
PubMed
Department of Specialized Medicine, Federal University of Piauí, Teresina, Brazil;
Search for other papers by Rafael D. Moura in
Current site
Google Scholar
PubMed
Antônio J. Meneses-Filho
Antônio J. Meneses-Filho
Department of Community Medicine, Federal University of Piauí, Teresina, Brazil;
Search for other papers by Antônio J. Meneses-Filho in
Current site
Google Scholar
PubMed
Search for other papers by Antônio J. Meneses-Filho in
Current site
Google Scholar
PubMed
Caio V. V. M. Furtado
Caio V. V. M. Furtado
University Hospital of the Federal University of Piauí, Teresina, Brazil;
Search for other papers by Caio V. V. M. Furtado in
Current site
Google Scholar
PubMed
Search for other papers by Caio V. V. M. Furtado in
Current site
Google Scholar
PubMed
Washington L. C. Santos
Washington L. C. Santos
Oswaldo Cruz Foundation, Gonçalo Moniz Institute, Salvador, Brazil;
Search for other papers by Washington L. C. Santos in
Current site
Google Scholar
PubMed
Search for other papers by Washington L. C. Santos in
Current site
Google Scholar
PubMed
Dorcas L. Costa
Dorcas L. Costa
Maternal and Child Department, Federal University of Piauí, Teresina, Brazil;
Fundação Municipal de Saúde of Teresina;
Tropical Diseases Institute “Natan Portella”, Teresina, Brazil;
Search for other papers by Dorcas L. Costa in
Current site
Google Scholar
PubMed
Fundação Municipal de Saúde of Teresina;
Tropical Diseases Institute “Natan Portella”, Teresina, Brazil;
Search for other papers by Dorcas L. Costa in
Current site
Google Scholar
PubMed
Kelsen D. Eulálio
Kelsen D. Eulálio
Fundação Municipal de Saúde of Teresina;
Tropical Diseases Institute “Natan Portella”, Teresina, Brazil;
Search for other papers by Kelsen D. Eulálio in
Current site
Google Scholar
PubMed
Tropical Diseases Institute “Natan Portella”, Teresina, Brazil;
Search for other papers by Kelsen D. Eulálio in
Current site
Google Scholar
PubMed
Gabriel R. Ferreira
Gabriel R. Ferreira
Department of Microbiology-Infectious Disease and Immunology, Faculty of Medicine, University Laval, Québec, Canada
Search for other papers by Gabriel R. Ferreira in
Current site
Google Scholar
PubMed
Search for other papers by Gabriel R. Ferreira in
Current site
Google Scholar
PubMed
Carlos H. N. Costa
Carlos H. N. Costa
Department of Community Medicine, Federal University of Piauí, Teresina, Brazil;
Center for Intelligence on Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil;
Tropical Diseases Institute “Natan Portella”, Teresina, Brazil;
Search for other papers by Carlos H. N. Costa in
Current site
Google Scholar
PubMed
Center for Intelligence on Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil;
Tropical Diseases Institute “Natan Portella”, Teresina, Brazil;
Search for other papers by Carlos H. N. Costa in
Current site
Google Scholar
PubMed
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.
- Supplemental Materials (PDF 67 KB)
Author Notes
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.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Desjeux P , Alvar J , 2003. Leishmania/HIV co-infections: epidemiology in Europe. Ann Trop Med Parasitol 97: 3–15.
-
2.
Alvar J et al.2008. The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev 21: 334–359.
-
3.
Olivier M , Badaró R , Medrano FJ , Moreno J , 2003. The pathogenesis of Leishmania/HIV co-infection: cellular and immunological mechanisms. Ann Trop Med Parasitol 97: 79–98.
-
4.
Wolday D , Akuffo H , Demissie A , Britton S , 1999. Role of Leishmania donovani and its lipophosphoglycan in CD4+ T-cell activation-induced human immunodeficiency virus replication. Infect Immun 67: 5258–5264.
-
5.
van Griensven J , Carrillo E , López-Vélez R , Lynen L , Moreno J , 2014. Leishmaniasis in immunosuppressed individuals. Clin Microbiol Infect 20: 286–299.
-
6.
Troya J , Casquero A , Muñiz G , Fern’ndez-Guerrero ML , Górgolas M , 2006. The role of splenectomy in HIV-infected patients with relapsing visceral leishmaniasis. Parasitology 134: 621–624.
-
7.
Bryan P , 1952. Splenectomy in a case of kala-azar; comments on a case. Rev Esp Pediatr 8: 95–99.
-
8.
Das A , Sen Gupta PC , 1950. Relapse of kala-azar after splenectomy. Lancet 256: 681–683.
-
9.
Lyngdoh E , Jain SC , Barua P , 1971. Splenectomy in treatment of drug resistant kala-azar. J Indian Med Assoc 57: 458–461.
-
10.
Dutra RA , Dutra LF , Reis M de O , Lambert RC , 2012. Splenectomy in a patient with treatment-resistant visceral leishmaniasis: a case report. Rev Soc Bras Med Trop 45: 130–131.
-
11.
Alon D , Chowers M , 2012. Successful therapeutic splenectomy in an HIV patient with relapsing visceral leishmaniasis. Int J STD AIDS 23: 289–290.
-
12.
Berman J , 2003. Current treatment approaches to leishmaniasis. Curr Opin Infect Dis 16: 397–401.
-
13.
Tsoukas CM , 1998. Effect of splenectomy on slowing human immunodeficiency virus disease progression. Arch Surg 133: 25–31.
-
14.
Brasil Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância Epidemiológica , 2011 . Manual de Recomendações Para Diagnóstico, Tratamento e Acompanhamento de Pacientes Com a Coinfecção Leishmania-HIV. Normas e Manuais Técnicos.
-
15.
Brasil Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância Das Doenças Transmissívei , 2015 . Manual of Recommendations for Diagnosis, Treatment and Follow-up of Patients with Leishmaniasis–HIV Coinfection.
-
16.
Brasil Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância Epidemiológica, 2014 . Manual de Vigilância e Controle da Leishmaniose Visceral.
-
17.
Li R , Duffee D , Gbadamosi-Akindele MF , 2021. CD4 Count. In: StatPearls. Treasure Island, FL: StatPearls Publishing.
-
18.
Pizzuto J , Ambriz R , 1984. Therapeutic experience on 934 adults with idiopathic thrombocytopenic purpura: multicentric trial of the Cooperative Latin American Group on Hemostasis and Thrombosis. Blood 64: 1179–1183.
-
19.
Katkhouda N , Hurwitz MB , Rivera RT , Chandra M , Waldrep DJ , Gugenheim J , Mouiel J , 1998. Laparoscopic splenectomy. Ann Surg 228: 568–578.
-
20.
Lozano-Salazar RR , Herrera MF , Vargas-Vorácková F , López-Karpovitch X , 1998. Laparoscopic versus open splenectomy for immune thrombocytopenic purpura. Am J Surg 176: 366–369.
-
21.
Rosen M , Brody F , Walsh RM , Tarnoff M , Malm J , Ponsky J , 2002. Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc 16: 272–279.
-
22.
Sarangi J , Coleby M , Trivella M , Reilly S , 1997. Prevention of post splenectomy sepsis: a population based approach. J Public Health (Oxf) 19: 208–212.
-
23.
Crary SE , Buchanan GR , 2009. Vascular complications after splenectomy for hematologic disorders. Blood 114: 2861–2868.
-
24.
Zijlstra EE , 2016. The immunology of post-kala-azar dermal leishmaniasis (PKDL). Parasit Vectors 9: 464.
-
25.
Singh N , Ramesh V , Arora VK , Bhatia A , Kubba A , Ramam M , 1998. Nodular post-kala-azar dermal leishmaniasis: a distinct histopathological entity. J Cutan Pathol 25: 95–99.
-
26.
Reinaldo LGC , Araújo RJC Jr. , Diniz TM , de Deus Moura R , Costa DL , Eulálio KD , Costa CHN , 2020. Recurrent kala-azar: report of two cured cases after total splenectomy. Rev Inst Med Trop Sao Paulo 62: e31.
-
27.
Leite de Sousa-Gomes M , Romero GAS , Werneck GL , 2017. Visceral leishmaniasis and HIV/AIDS in Brazil: are we aware enough? PLoS Negl Trop Dis 11: e0005772.
-
28.
Akuffo H , Costa C , van Griensven J , Burza S , Moreno J , Herrero M , 2018. New insights into leishmaniasis in the immunosuppressed. PLoS Negl Trop Dis 12: e0006375.
-
29.
Feldman LS , Demyttenaere SV , Polyhronopoulos GN , Fried GM , 2008. Refining the selection criteria for laparoscopic versus open splenectomy for splenomegaly. J Laparoendosc Adv Surg Tech A 18: 13–19.
-
30.
Qu Y , Xu J , Jiao C , Cheng Z , Ren S , 2014. Long-term outcomes of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura. Int Surg 99: 286–290.
-
31.
Singer DB , 1973. Postsplenectomy sepsis. Perspect Pediatr Pathol 1: 285–311.
-
32.
Styrt BA , 1996. Risks of infection and protective strategies for the asplenic patient. Infect Dis Clin Pract 5: 94–100.
-
33.
Hansen K , Singer DB , 2001. Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited. Pediatr Dev Pathol 4: 105–121.
-
34.
Lynch AM , Kapila R , 1996. Overwhelming postsplenectomy infection. Infect Dis Clin North Am 10: 693–707.
-
35.
Cunha BA , 1998. Infections in nonleukopenic compromised hosts (diabetes mellitus, SLE, steroids, and asplenia) in critical care. Crit Care Clin 14: 263–282.
-
36.
Marques RG , Petroianu A , 2003. Infecção fulminante pós-esplenectomia. Arq Gastroenterol 40: 47–54.
-
37.
Droz N , Hsia Y , Ellis S , Dramowski A , Sharland M , Basmaci R , 2019. Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries: a systematic review and meta-analysis. Antimicrob Resist Infect Control 8: 207.
-
38.
Long B , Koyfman A , Gottlieb M , 2021. Complications in the adult asplenic patient: a review for the emergency clinician. Am J Emerg Med 44: 452–457
-
39.
Lima IP , Müller MC , Holanda TA , Harhay M , Costa CHN , Costa DL , 2013. Human immunodeficiency virus/Leishmania infantum in the first foci of urban American visceral leishmaniasis: clinical presentation from 1994 to 2010. Rev Soc Bras Med Trop 46: 156–160.
-
40.
Lindoso JAL , Moreira CHV , Cunha MA , Queiroz IT , 2018. Visceral leishmaniasis and HIV coinfection: current perspectives. HIV AIDS (Auckl) 10: 193–201
-
41.
Vechi HT , de Sousa ASV , da Cunha MA , Shaw JJ , Luz KG , 2020. Case report: combination therapy with liposomal amphotericin B, N-methyl neglumine antimoniate, and pentamidine isethionate for disseminated visceral leishmaniasis in a splenectomized adult patient. Am J Trop Med Hyg 102: 268–273.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1767 | 700 | 92 |
| Full Text Views | 177 | 63 | 0 |
| PDF Downloads | 140 | 20 | 0 |