Naslov
Management of visceral leishmaniasis in SE Europe - from guidelines to real-life settings

Autori
Lukas, Davorka

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Skup
1st South-East European Conference on Travel, Tropical, Migration Medicine and HIV & 2nd Croatian Congress on Travel, Tropical, Migration Medicine & HIV

Mjesto i datum
Dubrovnik, Hrvatska, 28.09.2017. - 01.10.2017

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Domaća recenzija

Ključne riječi
Visceral leishmaniasis ; SE Europe

Sažetak
The leishmaniasis are parasitic diseases transmitted by sandflies. There are three main clinical syndromes of symptomatic infection: visceral, cutaneous and mucocutaneous. Visceral leishmaniasis (VL), is the most severe form of leishmaniasis and without treatment is associated with high fatality. VL causes an estimated 500 000 human cases and over 50 000 deaths worldwide each year. Close to 90% of these cases occur in the Indian subcontinent, Brazil and East Africa. According to recent WHO estimates in endemic countries of the WHO European Region, annual incidence of VL is around 1100 to 1900 cases, that is less than 2% of the global burden. The most affected countries are Georgia, Spain, Albania, Italy, Turkey, Tajikistan and Azerbaijan. Over the past decades, the incidence of VL has been declining in many endemic regions where living standards have improved. VL/ HIV coinfection has also been declining in Europe in the past few years, thanks to antiretroviral therapies (ART). In Southeast Europe, except Albania, the estimated annual VL incidence is nine to 13 and Leishmania– HIV coinfections are very infrequent. Autochthonous VL is caused by Leishmania infantum, which has domestic dogs as its main reservoir host and several phlebotomine species of the subgenus Phlebotomus as competent vectors. The diagnosis of VL is based on medical history with epidemiological data, physical examination and laboratory diagnosis (demonstration of parasite, parasite culture, serum antibody test, detection of parasite DNA). Visualization of the amastigote form of the parasite by microscopic examination of aspirates from bone marrow, spleen or lymph nodes is the classical confirmatory test for VL and most commonly used techniques. In the Manual on case management and surveillance of the leishmaniases in the WHO European Region (2016), a new diagnostic protocol is established. The first step in VL diagnostic algorithm is to perform a rapid diagnostic test (rK39 RDT). This test is immunochromatographic strip test using rK39 antigen that has high positive predictive value in Europe and VL is very probable when the test result is positive. Confirmatory parasitology methods, wherever available should be performed before starting the treatment. If other methods are not available and a patient is rK39 RDT tested positive, treatment should be started. This RDT should be implemented in diagnostic algorithm in the region. In most Southeast European countries the first-line treatment for VL is still with antimonials, while the recommended first-line treatment of VL in the WHO European region is Liposomal amphotericin B (IV).

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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