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Journal of Tropical Medicine
Volume 2012, Article ID 281572, 7 pages
http://dx.doi.org/10.1155/2012/281572
Clinical Study

American Visceral Leishmaniasis: Factors Associated with Lethality in the State of São Paulo, Brazil

1Centro de Vigilância Epidemiológica “Prof. Alexandre Vranjac”, Coordenadoria de Controle de Doenças, SES, 01246-902 São Paulo, SP, Brazil
2Departamento de Doenças Tropicais e Diagnóstico Por Imagem, Universidade Estadual Paulista Júlio de Mesquita Filho, 18618-970 Botucatu, SP, Brazil
3Departamento de Epidemiologia, Faculdade de Saúde Pública Universidade de São Paulo, 01246-904 São Paulo, SP, Brazil
4Instituto de Infectologia Emílio Ribas, SES, 01246-900 São Paulo, SP, Brazil
5Laboratório de Soroepidemiologia (LIM 38 HC-FMUSP), Instituto de Medicina Tropical Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil

Received 1 June 2012; Revised 10 August 2012; Accepted 14 August 2012

Academic Editor: Maria Aparecida Shikanai Yasuda

Copyright © 2012 Geraldine Madalosso et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. To identify factors associated with death in visceral leishmaniasis (VL) cases. Patients and Methodology. We evaluated prognostic factors for death from VL in São Paulo state, Brazil, from 1999 to 2005. A prognostic study nested in a clinical cohort was carried out by data analysis of 376 medical files. A comparison between VL fatal cases and survivors was performed for clinical, laboratory, and biological features. Association between variables and death was assessed by univariate analysis, and the multiple logistic regression model was used to determine adjusted odds ratio for death, controlling confounding factors. Results. Data analysis identified 53 fatal cases out of 376 patients, between 1999 and 2005 in São Paulo state. Lethality was 14.1% (53/376), being higher in patients older than fifty years. The main causes of death were sepsis, bleeding, liver failure, and cardiotoxicity due to treatment. Variables significantly associated with death were severe anemia, bleeding, heart failure, jaundice, diarrhea, fever for more than sixty days, age older than fifty years, and antibiotic use. Conclusion. Educational health measures are needed for the general population and continuing education programs for health professionals working in the affected areas with the purpose of identifying and treating early cases, thus preventing the disease evolution towards death.