Table 7.
Presentation and management of incident visceral leishmaniasis cases diagnosed in public hospitals in Mainland Portugal in 2010–2020, by NUTS2 region of residence: Norte, Centro, Área Metropolitana de Lisboa, Alentejo and Algarve
| Global | Norte | Centro | AML | Alentejo | Algarve | P-value | |
|---|---|---|---|---|---|---|---|
| Number, n | 194 | 37 | 36 | 79 | 18 | 24 | |
| Children under 5 years old, % (n) | 18.9 | 20.6 | 17.4 | 16.7 | 35.3 | 13 | 0.449 |
| (33/175) | (7/34) | (4/23) | (13/78) | (6/17) | (3/23) | (FET) | |
| Immunosuppressed patients, % (n) | 61.1 | 50.0 | 65.2 | 69.2 | 35.3 | 65.2 | 0.060 |
| (107/175) | (17/34) | (15/23) | (54/78) | (6/17) | (15/23) | (χ 2 = 9.027, df = 4) | |
| PLWH, % (n) | 46.9 | 29.4 | 47.8 | 61.5 | 17.6 | 43.5 | 0.002 |
| (82/175) | (10/34) | (11/23) | (48/78) | (3/17) | (10/23) | (χ 2 = 16.846, df = 4) | |
| Median time from onset to presentation, weeks (IQI) | 4.0 | 3.0 | 8.0 | 4.0 | 2.0 | 2.0 | 0.086 |
| [1.5–11.0] | [1.0–12.0] | [2.5–17.0] | [2.0–10.0] | [1.0–4.0] | [1.0–5.5] | (H = 8.152, df = 4) | |
| Department of consultation/ward, % ( n ) | |||||||
| Internal Medicine | 43.5 | 34.6 | 35.3 | 33.3 | 62.5 | 85.0 | < 0.001 (FET) |
| (57/131) | (9/26) | (6/17) | (20/60) | (5/8) | (17/20) | ||
| Infectious Diseases | 51.1 | 46.2 | 58.8 | 66.7 | 25.0 | 15.0 | |
| (67/131) | (12/26) | (10/17) | (40/60) | (2/8) | (3/20) | ||
| Hospital admission, % ( n ) | 94.5 | 87.1 | 89.5 | 97.4 | 93.3 | 100 | 0.094 |
| (155/164) | (27/31) | (17/19) | (74/76) | (14/15) | (23/23) | (FET) | |
| Median duration, days (IQI) | 20.0 | 16.5 | 29.0 | 20.0 | 16.0 | 29.0 | 0.290 |
| [12.0–36.0] | [7.0–35.25] | [13.0–41.0] | [11.75–32.75] | [11.0–23.0] | [14.0–56.0] | (H = 4.973, df = 4) | |
| Median time from presentation to diagnosis, days (IQI) | 10.0 | 12.0 | 8.0 | 8.0 | 15.0 | 20.0 | 0.004 |
| [4.5–19.5] | [2.5–26.5] | [2.25–20.75] | [4.0–15.0] | [7.0–50.0] | [8.0–60.0] | (H = 15.413, df = 4) | |
| Samples used (direct diagnosis), % ( n ) | |||||||
| Bone marrow | 94.1 | 87.9 | 88.0 | 98.7 | 92.9 | 95.7 | 0.054 |
| (160/170) | (29/33) | (22/25) | (74/75) | (13/14) | (22/23) | (FET) | |
| Blood | 17.8 | 27.6 | 5.9 | 13.6 | 41.7 | 13.6 | 0.066 |
| (26/146) | (8/29) | (1/17) | (9/66) | (5/12) | (3/22) | (FET) | |
| Technique used in bone marrow sample, % ( n ) | |||||||
| Microscopy | 95.6 | 92.6 | 91.7 | 95.9 | 100 | 100 | 0.609 |
| (152/159) | (25/27) | (22/24) | (70/73) | (13/13) | (22/22) | (FET) | |
| PCR | 41.6 | 39.3 | 43.5 | 44.6 | 76.9 | 10.0 | 0.004 |
| (62/149) | (11/28) | (10/23) | (29/65) | (10/13) | (2/20) | (χ 2 = 15.234, df = 4) | |
| Culture | 22.7 | 46.4 | 22.7 | 35.5 | 22.2 | 0 | 0.002 |
| (32/141) | (13/28) | (5/22) | (22/62) | (2/9) | (0/20) | (FET) | |
| Serology, % ( n ) | 52.5 | 46.9 | 60.0 | 59.1 | 69.2 | 22.7 | 0.022 |
| (83/158) | (15/32) | (15/25) | (39/66) | (9/13) | (5/22) | (χ 2 = 11.400, df = 4) | |
| Samples sent to reference laboratory, % ( n ) | 40.0 | 33.3 | 11.1 | 46.3 | 80.0 | 27.3 | 0.014 |
| (50/125) | (10/30) | (1/9) | (25/54) | (8/10) | (6/22) | (FET) | |
| Treatment of primary episode, % ( n ) | |||||||
| Median tme from diagnosis to treatment, days (IQI) | 0.0 | 0.0 | 1.0 | 0.0 | 0.0 | 0.0 | 0.001 |
| [0.0–1.0] | [0.0–3.0] | [0.0–2.5] | [0.0–5.0] | [0.0–1.75] | [0.0–0.0] | (H = 18.384, df = 4) | |
| Median duration of treatment, days (IQI) | 21.0 | 21.0 | 21.0 | 21.0 | 21.0 | 21.0 | 0.954 |
| [10.0–38.0] | [10.0–38.0] | [18.0–28.0] | [10.0–38.0] | [11.0–38.0] | [10.0–38.0] | (H = 0.681, df = 4) | |
| Outcome of treatment, % ( n ) | |||||||
| Improvement at 7 days | 88.6 | 80.8 | 76.5 | 91.4 | 100 | 91.3 | 0.176 |
| (132/149) | (21/26) | (13/17) | (64/70) | (13/13) | (21/23) | (FET) | |
| Improvement at 30 days | 96.4 | 96.2 | 92.9 | 98.5 | 90.9 | 95.7 | 0.306 |
| (135/140) | (25/26) | (13/14) | (65/66) | (10/11) | (22/23) | (FET) | |
| Follow-up in consultation, % ( n ) | |||||||
| Yes | 93.3 | 100 | 81.3 | 91.5 | 92.9 | 100 | 0.880 |
| (140/150) | (26/26) | (13/16) | (65/71) | (13/14) | (23/23) | (FET) | |
| Median time to first consultation, days (IQI) | 15.5 | 12.0 | 21.5 | 12.0 | 13.0 | 30.0 | 0.004 |
| [7.0–30.0] | [7.0–28] | [7.75–43.75] | [5.5–27.0] | [7.0–16.0] | [18.0–55.0] | (H = 15.318, df = 4) | |
| Cure test performed | 16.9 | 28.6 | 0 | 16.1 | 10.0 | 17.4 | 0.236 |
| (23/136) | (8/28) | (0/13) | (10/62) | (1/10) | (4/23) | (FET) | |
AML Área Metropolitana de Lisboa, IQI Interquartile interval, FET Fisher’s exact test, PCR Polymerase chain reaction, PLWH People living with HIV