Evaluation of Adult Cases of Visceral Leishmaniasis Reported in Turkey by Pool Analysis Method

Abstract

Objective: In this study, we aimed to to emphasize that visceral leishmaniasis exists in Turkey, and to discuss its clinical and laboratory findings and therapeutic approaches by evaluating the adult cases reported from Turkey through a pool analysis. Methods: The published reports in national or international journals on adult visceral leishmaniasis cases, between 1997 and 2019, from Turkey, were searched in a national (TUBITAK ULAKBIM) and two international databases (PubMed and Scopus). The cases were examined by the pool analysis method in terms of age, gender, immunosuppression, symptoms, laboratory findings, diagnosis, treatment, and mortality. Results: Eighty cases were included in the study, 34.2% (27/79) were female, and 64.8% (52/79) were male. Patients were between 18-75 years of age, and mean age was 41.2 +/- 14.2 years. Ratio of immunosuppressed patients was 25% (15/60). Most common symptoms were fever, weight loss, and fatigue. Splenomegaly was observed in 96.2% (76/79) and hepatomegaly was seen in 78.5% (62/79) of the cases. Diagnosis was made in 88.7% (63/71) of patients through detection of an amastigote on bone marrow aspiration and/or biopsy. The immunofluorescent antibody test and the enzyme-linked immunosorbent assay test were found to be 100% positive. Positivity of rK39 rapid antigen test was 86.6% (13/15). 80.5% (62/77) of the patients were treated with liposomal amphotericin B and 11.6% (9/77) with pentavalent antimony compound (meglumine antimonate). The mortality rate was 13.9% (11/79). Conclusions: Visceral leishmaniasis is seen sporadically in adults in Turkey, and it is not considered in the differential diagnosis. Invasive procedures are used for diagnosis. We think that serological examinations, especially in the presence of fever and splenomegaly, may be beneficial for the diagnosis and successful treatment of the patients, especially if the patient is not immunosuppressed.