Clinical, Laboratory, and Therapeutic Characteristics of Visceral Leishmaniasis with Emphasis on Immune Status: A Multicentre Cohort Study in Greece
Our latest research paper was published in open access in Pathogens on 28 January 2026:
Clinical, Laboratory, and Therapeutic Characteristics of Visceral Leishmaniasis with Emphasis on Immune Status: A Multicentre Cohort Study in Greece
by
Aristos Aristodimou, Achilleas Gikas, Maria Antoniou, Karolina Akinosoglou, Nikolaos Partalis, Angelos Pefanis, Periklis Panagopoulos, Charalambos Christofidis, and Evangelos I. Kritsotakis
Abstract: Visceral leishmaniasis (VL) is an endemic zoonotic disease in southern Europe with increasing clinical relevance among immunocompromised populations; however, detailed clinical data remain scarce. This retrospective multicentre cohort study analysed patients with confirmed VL treated at seven hospitals in Greece over a 26-year period. Clinical, treatment, and outcome data were collected with a minimum follow-up of 18 months to assess cure, treatment failure, relapse, and mortality. A total of 144 patients were enrolled (59% male; mean age 41.8 years, range 0.1–84 years), most of whom were Greek nationals (85%) and resided in rural areas (61%). Fever was the primary reason for hospital admission in 95% of patients. At diagnosis, 42 patients (29%) were immunocompromised. These patients were significantly older than immunocompetent individuals and more likely to present with diarrhoea and arthralgia, whereas hepatomegaly was less frequent. Liposomal amphotericin B was administered to 90% of patients. Treatment failure occurred in 14 patients (10%) and was significantly associated with immunosuppression and leukaemia. Relapse within 18 months occurred in 5.5% of patients. Overall mortality was relatively low (7 patients, 5%), with one death directly attributable to VL. This study demonstrates that VL remains endemic in Greece, affects patients across all age groups, and is primarily autochthonous. Immunosuppression is associated with distinct clinical features and poorer treatment outcomes in VL, underscoring the need for heightened clinical vigilance, combined diagnostic approaches, and extended follow-up in vulnerable populations.
Keywords: visceral leishmaniasis; immunosuppression; Mediterranean region; Greece; Leishmania infantum; treatment outcome.
Access the full paper via:Statistical Analysis
Categorical data were presented as frequency counts and percentages and compared across patient groups using Pearson's chi-squared test or Fisher's exact test when sample sizes were small (resulting in expected frequencies < 5). Continuous data were summarised as mean and standard deviation and were compared between groups using the t-test. When sample sizes were small (n < 25 per group) and distributions were skewed or contained extreme outliers, continuous data were summarised as median and interquartile range (IQR) and the Wilcoxon–Mann–Whitney U test was used for between-group comparisons. Comparisons were made between immunocompetent and immunocompromised patients, and between groups defined by cure and treatment failure. A two-tailed p-value < 0.05 was considered to indicate statistical significance. Complete case analyses were performed, and missing data due to an inability to retrieve relevant information were noted as "unknown" in the tables of results. Due to the small effective sample sizes (i.e., small numbers of immunocompromised patients and treatment failures), multivariable regression analysis was not possible. Data were processed and analysed using STATA v.19 (StataCorp, College Station, TX, USA).
Figure 1. Distribution of patients with visceral leishmaniasis according to age.
