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Reinaldo LGC, Araújo-Júnior RJC, Diniz TM, Moura RD, Meneses-Filho AJ, Furtado CVVM, Santos WLC, Costa DL, Eulálio KD, Ferreira GR, Costa CHN. Splenectomy in Patients with Visceral Leishmaniasis Resistant to Conventional Therapy and Secondary Prophylaxis: A Retrospective Cohort. Am J Trop Med Hyg 2022; 107:342-348. [PMID: 35895427 PMCID: PMC9393438 DOI: 10.4269/ajtmh.21-0376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 03/23/2022] [Indexed: 07/30/2023] Open
Abstract
Some patients with visceral leishmaniasis (VL), or kala-azar, suffer relapses and low quality of life despite adequate drug therapy, especially those co-infected with HIV. Occasionally, physicians indicate splenectomy, but the benefit of the procedure needs to be analyzed systematically. Therefore, a retrospective open cohort study was conducted in Teresina, Brazil. Inpatients from a reference hospital with relapsing VL who had a rescue splenectomy between 2012 and 2019 after the nationally recommended drug therapy failed were studied. The procedure's risks and benefits were assessed in a limited-resource setting. The primary outcomes were surgical complications, complete blood count, CD4+ cell count, hospitalizations, survival time, and medical complications preceding death. Thirteen adult patients received medical and surgical indications of splenectomy (12 men and one woman). Eleven had HIV infection. Two had early and two had late complications. Four died, all of whom were infected with HIV. An additional HIV-coinfected patient, apart from the cohort, died just before surgery. The death rate after surgery was 13.3 overall and 22.1 per 100 person-years among HIV-infected patients (31% overall and 36%, respectively). The impressive rise of complete blood counts and reduction of blood transfusions and hospitalizations were observed among all patients. Also, a meaningful increase in CD4+ cells in HIV-infected patients was noted. Splenectomy may benefit patients with relapsing VL. However, before performing splenectomy, available combined drug therapy for VL should be tried.
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Affiliation(s)
- Luis G. C. Reinaldo
- University Hospital of the Federal University of Piauí, Teresina, Brazil
- Hospital Getúlio Vargas, Teresina, Brazil
| | - Raimundo J. C. Araújo-Júnior
- University Hospital of the Federal University of Piauí, Teresina, Brazil
- Hospital Getúlio Vargas, Teresina, Brazil
- Department of Specialized Medicine, Federal University of Piauí, Teresina, Brazil
| | - Thiago M. Diniz
- University Hospital of the Federal University of Piauí, Teresina, Brazil
| | - Rafael D. Moura
- University Hospital of the Federal University of Piauí, Teresina, Brazil
- Department of Specialized Medicine, Federal University of Piauí, Teresina, Brazil
| | | | | | | | - Dorcas L. Costa
- Maternal and Child Department, Federal University of Piauí, Teresina, Brazil
- Fundação Municipal de Saúde of Teresina
- Tropical Diseases Institute “Natan Portella”, Teresina, Brazil
| | - Kelsen D. Eulálio
- Fundação Municipal de Saúde of Teresina
- Tropical Diseases Institute “Natan Portella”, Teresina, Brazil
| | - Gabriel R. Ferreira
- Department of Microbiology-Infectious Disease and Immunology, Faculty of Medicine, University Laval, Québec, Canada
| | - Carlos H. N. Costa
- Department of Community Medicine, Federal University of Piauí, Teresina, Brazil
- Center for Intelligence on Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil
- Tropical Diseases Institute “Natan Portella”, Teresina, Brazil
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Borjaili ASD, Nunes GC, Silveira JB, Dall'Orto FH, Lorenzoni GS, Borjaili MED, Campagnaro BP, de Lima MCM, Paulo MSL, Paulo DNS, Nunes TA. The influence of splenic tissue on the survival and TCD4 and TCD8 lymphocyte rates in rats subjected to fecal peritonitis induction. Acta Cir Bras 2020; 35:e202001003. [PMID: 33237175 PMCID: PMC7709900 DOI: 10.1590/s0102-865020200100000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/08/2020] [Accepted: 09/04/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Comparing survival rates of rats subjected to spleen procedures after fecal peritonitis induction. Assessing changes in TCD4 and CD8 lymphocyte rates before and after the procedures. Correlating animal survival with CD4 and CD8 lymphocytes. METHODS Thirty male Wistar rats were distributed into 3 groups of ten: spleen manipulation (SM); total splenectomy (TS); subtotal splenectomy with preservation of the inferior pole (IP). Rats were subjected to surgical procedure depending on the group. Seven days after surgery they underwent induction of peritonitis and survival time was recorded. All animals were subjected to two blood collections: before surgery and 70 days after it for TCD4/TCD8 lymphocyte counting. RESULTS Mean survival time was longer in the IP and SM groups and shorter in the TS group; there was significant difference between them. The comparison of the median number of CD4 did not present changes, whereas the comparison of the median number of CD8 decreased in the SM and IP groups. The correlation between the median number of TCD4 and TCD8 lymphocytes and the animals' survival was not significant. CONCLUSION The maintenance of splenic tissue contributed to increase the survival of rats and there was a change in the number of TCD8 lymphocytes.
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Affiliation(s)
- Andréa Saade Daher Borjaili
- Fellow PhD degree, Postgraduate Program in Surgical and Ophthalmological Applied Sciences, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte-MG, Brazil. Scientific and intellectual contributions to the study, analysis and interpretation of data, manuscript preparation and writing
| | - Giseli Celestino Nunes
- Graduate student, School of Sciences, Santa Casa de Misericórdia de Vitória (EMESCAM), Vitoria-ES, Brazil. Acquisition of data, technical procedures
| | - Julia Belizário Silveira
- Graduate student, School of Sciences, Santa Casa de Misericórdia de Vitória (EMESCAM), Vitoria-ES, Brazil. Acquisition of data, technical procedures
| | | | - Gabriel Souza Lorenzoni
- Graduate student, School of Sciences, Santa Casa de Misericórdia de Vitória (EMESCAM), Vitoria-ES, Brazil. Acquisition of data, technical procedures
| | | | - Bianca Prandi Campagnaro
- PhD, Full, Professor, Laboratory of Translational Physiology and Pharmacology, Pharmaceutical Sciences Graduate Program, Universidade Vila Velha (UVV), Brazil. Flow cytometry protocols, analysis of data
| | | | - Marcela Souza Lima Paulo
- PhD, Associate Professor, School of Sciences, EMESCAM, Vitoria-ES, Brazil. Intellectual and scientific content of the study, manuscript preparation, critical revision
| | - Danilo Nagib Salomão Paulo
- PhD, Chairman, Full Professor, Department of Surgery, School of Sciences, EMESCAM, Vitoria-ES, Brazil. Intellectual, scientific, conception and design of the study; critical revision; final approval
| | - Tarcizo Afonso Nunes
- PhD, Chairman, Full Professor, Department of Surgery, UFMG, Belo Horizonte-MG, Brazil. Intellectual and scientific content of the study, critical revision, final approval
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Reinaldo LGC, Araújo Júnior RJC, Diniz TM, Moura RDD, Costa DL, Eulálio KD, Costa CHN. Recurrent kala-azar: report of two cured cases after total splenectomy. Rev Inst Med Trop Sao Paulo 2020; 62:e31. [PMID: 32491143 PMCID: PMC7266615 DOI: 10.1590/s1678-9946202062031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022] Open
Abstract
In Latin America, the causative agent of kala-azar is the intracellular protozoan Leishmania infantum. Most cases in South America are reported in Brazil. Worldwide, it mainly affects Bangladesh, Ethiopia, India, South Sudan and Sudan. Despite the high morbidity and lethality of kala-azar, most infections are asymptomatic. However, a small portion of patients evolves with recurrence of kala-azar becoming symptomatic even after all available drug treatments. Kala-azar is not a formal indication for splenectomy in adults. Splenectomy is recommended as a saving measure, when kala-azar is associated with symptomatic hypersplenism and for drug-resistant cases. In the study, we report two cases of kala-azar with splenomegaly that presented several hospitalizations due to the recurrence of the kala-azar, in addition to hospitalizations for normalizing the blood count. After splenectomy, kala-azar cases and the effects of hypersplenism are cured. Thus, splenectomy should be seen as a surgical treatment option with a curative purpose in patients with recurrent kala-azar, in whom the possibilities of drug therapy have been exhausted and even so they progressed with hypersplenism and clinical repercussions.
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Affiliation(s)
| | | | - Thiago Melo Diniz
- Universidade Federal do Piauí, Hospital Universitário, Teresina, Piauí, Brazil
| | | | | | | | - Carlos Henrique Nery Costa
- Universidade Federal do Piauí, Teresina, Piauí, Brazil,Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil
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Mendonça FA, Carmo FPTD, Paris LG, Pagotte MD, Pereira FLA, Vidigal PVT, Paulo DNS, Nunes TA. Effects of inferior splenic lobe pole fixation and gastrosplenic peritoneal membrane section on the vitality of the remanent of subtotal splenectomy in rats. Acta Cir Bras 2016; 30:461-9. [PMID: 26270137 DOI: 10.1590/s0102-865020150070000003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 06/15/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the vitality of the spleen lower pole after subtotal splenectomy with suture to the stomach and after posterior peritoneal gastro-splenic membrane section, using macro and microscopic evaluations. METHODS Sixty Wistar rats were used in this study and were randomly distributed in the three groups: Group 1: (n=20), subtotal splenectomy with lower pole preservation, Group 2: (n=20) subtotal splenectomy with lower pole preservation and suture to the stomach, Group 3: subtotal splenectomy with lower pole preservation and posterior peritoneal gastrosplenic ligament section. The animals were sacrificed 45 days after the surgery and the spleen lower poles were removed for macroscopic and microscopic examination. RESULTS All animals in this series survived. No macroscopic differences were encountered between the groups. Microscopic evaluation observed statistic difference concerning fibrosis between group 1 and 3 (p ≤ 0.05), but the analysis for necrosis and inflammation presented no differences. CONCLUSION Vitality of the spleen lower pole after subtotal splenectomy is minimally modified when it is fixed to the stomach or when the posterior peritoneal gastrosplenic ligament is resected.
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.2014.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Negreiros RMDA, Makimoto FH, Santana LLO, Ferreira LCDL, Nakajima GS, Santos MCD. Experimental splenectomies and malaria in mice. Acta Cir Bras 2010; 24:437-41. [PMID: 20011827 DOI: 10.1590/s0102-86502009000600003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 07/14/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the importance of spleen in malaric infection in murino model, comparing the parasitemia and the titles of immunoglobulins in the different groups. METHODS It was used female mice non-isogenic, inoculated with Plasmodium berghei, cepa ANKA, intraperitoneally. The parasitemia was analyzed in 23rd, 25th, 27th and 32nd day of the experiment, being the stained blood exam colored by Giemsa. The titles of the total serum immunoglobulins IgM and IgG were analyzed by Dot-ELISA technique, at 6th, 22nd and 32nd day, when the animals were sacrificed. RESULTS The parasitemia was gradual in all the inoculated groups. In the end of the experiment, the animals with partial parasitemia present superior parasitemia, but next to the non-splenectomized, while the asplenics present difference bigger than the double. The levels of total serum IgM and IgG didn't have significant changes with the removal partial or total splenic. CONCLUSION The techniques conservatives in splenic trauma are possible and necessary. The importance of remaining spleen in the clearance of red blood cells parasitized by Plasmodium berghei showed being efficient, in order to avoid serious complications resulting of the malaria in mice.
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Maioli TU, Carneiro CM, Assis FA, Faria AMC. Splenectomy does not interfere with immune response to Leishmania major infection in mice. Cell Immunol 2008; 249:1-7. [PMID: 18093575 DOI: 10.1016/j.cellimm.2007.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 10/15/2007] [Accepted: 11/01/2007] [Indexed: 11/18/2022]
Abstract
Spleen is one of the largest lymphoid organs in the body; it harbors immune cells including antigen presenting cells, B and T lymphocytes. It has an important role in humoral and cellular immune responses. Herein we investigated the role of spleen in the immune response to experimental Leishmania major infection. It is known that C57BL/6 mice are resistant to L. major infection whereas BALB/c mice are susceptible. Although splenectomy was associated with reduced serum levels of IFN-gamma, absence of the spleen did not change the profile of L. major infection in the resistant C57BL/6 and BALB/c susceptible mice. Both strains of mice maintained the same profile of cytokine production in regional lymph nodes after splenectomy and responded in the same way against the infection. Only splenectomized BALB/c mice had a reduction in IL-4 and IL-10 production by lymph node cells early in infection. Our data suggest that, in localized infections, regional lymph nodes may replace efficiently the immunological role of spleen in the cellular and humoral immune responses.
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Affiliation(s)
- T U Maioli
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, 31270-901 Belo Horizonte, MG, Brazil
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Kato M, Shimohashi N, Ouchi J, Yoshida K, Tanabe Y, Takenaka K, Nakamuta M. Partial splenic embolization facilitates completion of interferon therapy in patients with chronic HCV infection and hypersplenism. J Gastroenterol 2005; 40:1076-7. [PMID: 16322955 DOI: 10.1007/s00535-005-1693-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Accepted: 06/14/2005] [Indexed: 02/04/2023]
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