Table 4.
Clinical presentation characteristics of visceral leishmaniasis primary episodes, diagnosed in public hospitals in Mainland Portugal, and incident between 2010 and 2020, globally and by group
| Global | CU5 | NISA | PLWH | ISA | P-value | |
|---|---|---|---|---|---|---|
| Number | 194 | 34 | 35 | 82 | 25 | |
| Median time from onset to presentation, weeks (IQI) | 4 | 2 | 5 | 4 | 4 | 0.01 |
| [1.5–11] | [1–3.5] | [1–19] | [2–14] | [1.75–9] | (H = 11.326, df = 3) | |
| Department of consultation/ward, % ( n ) | ||||||
| Infectious Diseases | 40.9 | 0 | 18.2 | 66.7 | 37.5 | < 0.001 (FET) (excluding CU5) |
| (67/164) | (0/29) | (6/33) | (52/78) | (9/24) | ||
| Internal Medicine | 34.8 | 0 | 69.7 | 32.1 | 37.5 | |
| (57/164) | (0/29) | (23/33) | (25/78) | (9/24) | ||
| Pediatrics | 20.1 | 100 | 9.1 | 0 | 4.2 | |
| (33/164) | (29/29) | (3/33) | (0/78) | (1/24) | ||
| Other | 6.7 | 0 | 6.1 | 1.3 | 33.3 | |
| (11/164) | (0/29) | (2/33) | (1/78) | (8/24) | ||
| Hospital admission, % ( n ) | 94.5 | 100 | 96.9 | 91.1 | 95.8 | 0.363 |
| (155/164) | (29/29) | (31/32) | (72/79) | (23/24) | (FET) | |
| Median duration, days (IQI) | 20 | 13.5 | 22 | 22 | 28 | 0.04 |
| [12–36] | [9.0–17.75] | [11–49.5] | [12–45.75] | [17–34.5] | (H = 13.247, df = 3) | |
| Critical care, % ( n ) | 8.8 | 0 | 0 | 13.0 | 16.7 | 0.012 |
| (14/160) | (0/27) | (0/32) | (10/77) | (4/24) | (FET) | |
| Median duration, days (IQI) | 8.5 | N/A | N/A | 8.5 | 9.0 | 0.734 |
| [4.25–13.75] | [4.5–17.25] | [2.75–13.75] | (U = 0.116) | |||
| Signs/Symptoms, % ( n ) | ||||||
| Splenomegaly | 90.0 | 100 | 87.9 | 93.2 | 75.0 | 0.011 |
| (153/170) | (30/30) | (29/33) | (69/74) | (18/24) | (FET) | |
| Fever | 71.9 | 96.6 | 69.7 | 59.7 | 70.8 | 0.004 |
| (115/160) | (28/29) | (23/33) | (40/67) | (17/24) | (χ 2 = 13.254, df = 3) | |
| Median highest value, ºC (IQI) | 39.0 | 39.5 | 39.0 | 39.0 | 39.1 | 0.029 |
| [38.6–40.0] | [39.0–40.0] | [38.75–40.0] | [38.2–39.2] | [39.0–40.0] | (H = 9.046, df = 3) | |
| Hepatomegaly | 71.8 | 63.3 | 60.6 | 88.0 | 56.5 | 0.001 |
| (122/170) | (19/30) | (20/33) | (66/75) | (13/23) | (χ 2 = 15.826, df = 3) | |
| Fatigue | 69.8 | 29.6 | 81.3 | 75.0 | 76.2 | < 0.001 |
| (113/162) | (8/27) | (26/32) | (54/72) | (16/21) | (χ 2 = 23.27, df = 3) | |
| Anorexia | 52.5 | 29.6 | 51.6 | 54.3 | 59.1 | 0.124 |
| (84/160) | (8/27) | (16/31) | (38/70) | (13/22) | (χ 2 = 5.755, df = 3) | |
| Weight loss | 49.7 | 13.0 | 56.7 | 57.6 | 36.4 | 0.001 |
| (75/151) | (3/23) | (17/30) | (38/66) | (8/22) | (χ 2 = 15.74, df = 3) | |
| Gastrointestinal signs/symptoms | 44.3 | 50.0 | 48.4 | 44.8 | 30.4 | 0.498 |
| (66/149) | (14/28) | (15/31) | (30/67) | (7/23) | (χ 2 = 2.377, df = 3) | |
| Respiratory signs/symptoms | 28.3 | 25.9 | 25.8 | 29.6 | 30.4 | 0.964 |
| (43/152) | (7/27) | (8/31) | (21/71) | (7/23) | (χ 2 = 0.279, df = 3) | |
| Lymphadenopathy | 23.0 | 14.3 | 29.0 | 27.5 | 13.0 | 0.272 |
| (37/161) | (4/28) | (9/31) | (19/69) | (3/23) | (χ 2 = 3.902, df = 3) | |
| Skin/mucosal hemorragea | 22.7 | 10.7 | 15.6 | 27.1 | 33.3 | 0.135 |
| (35/154) | (3/28) | (5/32) | (19/70) | (8/24) | (χ 2 = 5.534, df = 3) | |
| Neurological signs/symptoms | 14.3 | 7.1 | 12.9 | 15.3 | 21.7 | 0.519 |
| (22/154) | (2/28) | (4/31) | (11/72) | (5/23) | (FET) | |
| Peripheral edema | 12.8 | 0 | 12.5 | 16.4 | 17.4 | 0.097 |
| (19/149) | (0/27) | (4/32) | (11/67) | (4/23) | (FET) | |
| Abdominal image obtained, % ( n ) b | 96.9 | 96.6 | 97.0 | 96.0 | 100 | 1 |
| (155/160) | (28/29) | (32/33) | (72/75) | (23/23) | (FET) | |
| Analytical changes, % ( n ) | ||||||
| Anemia | 98.9 | 100 | 97 | 100 | 100 | 0.533 |
| (173/175) | (30/30) | (32/33) | (77/77) | (25/25) | (FET) | |
| Median lowest value, g/dL (IQI) | 7.6 | 6.7 | 8.1 | 7.7 | 7.6 | 0.267 |
| [6.6–8.5] | [6.3–7.3] | [7.3–8.7] | [6.65–8.45] | [6.7–8.8] | (H = 2.642, df = 3) | |
| Thrombocytopenia | 90.2 | 90.0 | 87.5 | 90.9 | 88.0 | 0.930 |
| (157/174) | (27/30) | (28/32) | (70/77) | (22/25) | (FET) | |
| Median lowest value, /µl (IQI) | 64,000 | 76,000 | 54,000 | 69,000 | 39,000 | 0.026 |
| [36,500–112,000] | [47,500–120,250] | [31,000–106,500] | [44,000–116,500] | [16,000–92,000] | (H = 7.271, df = 2) | |
| Leukopenia | 88.3 | 65.5 | 87.1 | 94.8 | 96 | < 0.001 |
| (143/162) | (19/29) | (27/31) | (73/77) | (24/25) | (FET) | |
| Median lowest value, /µl (IQI) | 2000 | 3450 | 1685 | 1765 | 1300 | 0.250 |
| [1272–2670] | [2597–4850] | [1025–2255] | [1200–2300] | [1077–1925] | (H = 2.769, df = 2) | |
| C-reactive protein elevation | 93.1 | 92.9 | 96.9 | 90.8 | 95.7 | 0.744 |
| (148/159) | (26/28) | (31/32) | (69/76) | (22/23) | (FET) | |
| Median highest value, mg/L (IQI) | 88.0 | 88.0 | 113.0 | 68.9 | 125.7 | 0.027 |
| [44.6–136.2] | [49.0–115.6] | [65.55–136.8] | [31.05–132.0] | [60.0–229.0] | (H = 7.254, df = 2) | |
| Acute kidney failure | 14.6 | 0 | 16.1 | 13.2 | 34.8 | 0.004 |
| (23/157) | (0/27) | (5/31) | (10/76) | (8/23) | (FET) | |
| Liver failure/decompensated chronic liver disease | 6.2 | 3.4 | 12.9 | 5.2 | 4.2 | 0.464 |
| (10/161) | (1/29) | (4/31) | (4/77) | (1/24) | (FET) | |
| Hemophagocytic lymphohistiocystosis, % ( n ) | 9.5 | 40.0 | 0 | 0 | 16.7 | < 0.001 |
| (14/147) | (10/25) | (0/31) | (0/67) | (4/24) | (FET) | |
| Coinfection/superinfection, % ( n ) | 14.6 | 34.5 | 29.0 | 50.7 | 43.5 | 0.163 |
| (23/157) | (10/29) | (9/31) | (38/75) | (10/23) | (χ 2 = 5.122, df = 3) | |
IQI Interquartile interval, FET Fisher’s exact test, CU5 Children 5 years of age or younger, NISA Non-immunosuppressed adults and children over 5 years old, ISA Non-HIV infected immunosuppressed adults, PLWH People living with HIV
aLower gastrointestinal tract n = 10, ecchymosis/hematoma/petechiae n = 8, epistaxis n = 7, hemoptysis n = 7, gingival n = 3, upper gastrointestinal tract n = 1, vaginal n = 1
bUltrasonography 72.3% (112/155), computed tomography scan 53.5% (83/155)