Micronutrient levels and their effects on the prognosis of visceral leishmaniasis treatment, a prospective cohort study.

BACKGROUND: Micronutrients are minerals and vitamins and they are essential for normal physiological activities. The objectives of the study were to describe the progress and determinants of micronutrient levels and to assess the effects of micronutrients in the treatment outcome of kalazar. METHODS: A prospective cohort study design was used. The data were collected using patient interviews, measuring anthropometric indicators, and collecting laboratory samples. The blood samples were collected at five different periods during the leishmaniasis treatments: before starting anti-leishmaniasis treatments, in the first week, in the second week, in the third week, and in the 4th week of anti-leishmaniasis treatments. Descriptive statistics were used to describe the profile of patients and to compare the treatment success rate. The generalized estimating equation was used to identify the determinants of serum micronutrients. RESULTS: The mean age of the patients were 32.88 years [SD (standard deviation) ±15.95]. Male constitute 62.3% of the patients and problematic alcohol use was present in 11.5% of the patients. The serum zinc level of visceral leishmaniasis patients was affected by alcohol (B - 2.7 [95% CI: - 4.01 - -1.5]), DDS (B 9.75 [95% CI: 7.71-11.79]), family size (B -1.63 [95% CI: - 2.68 - -0.58]), HIV (B -2.95 [95% CI: - 4.97 - -0.92]), and sex (B - 1.28 [95% CI: - 2.5 - -0.07]). The serum iron level of visceral leishmaniasis patients was affected by alcohol (B 7.6 [95% CI: 5.86-9.35]), family size (B -5.14 [95% CI: - 7.01 - -3.28]), malaria (B -12.69 [95% CI: - 14.53 - -10.87]), Hookworm (- 4.48 [- 6.82 - -2.14]), chronic diseases (B -7.44 [95% CI: - 9.75 - -5.13]), and HIV (B -5.51 [95% CI: - 8.23 - -2.78]). The serum selenium level of visceral leishmaniasis patient was affected by HIV (B -18.1 [95% CI: - 20.63 - -15.58]) and family size (B -11.36 [95% CI: - 13.02 - -9.7]). The iodine level of visceral leishmaniasis patient was affected by HIV (B -38.02 [95% CI: - 41.98 - -34.06]), DDS (B 25 .84 [95% CI: 22.57-29.1]), smoking (B -12.34 [95% CI: - 15.98 - -8.7]), chronic illness (B -5.14 [95% CI: - 7.82 - -2.46]), and regular physical exercise (B 5.82 [95% CI: 0.39-11.26]). The serum vitamin D level of visceral leishmaniasis patient was affected by HIV (B -9.43 [95% CI: - 10.92 - -7.94]), DDS (B 16.24 [95% CI: 14.89-17.58]), malaria (B -0.61 [95% CI: - 3.37 - -3.37]), and family size (B -1.15 [95% CI: - 2.03 - -0.28]). The serum vitamin A level of visceral leishmaniasis patient was affected by residence (B 0.81 [95% CI: 0.08-1.54]), BMI (B 1.52 [95% CI: 0.42-2.6]), DDS (B 1.62 [95% CI: 0.36-2.88]), family size (B -5.03 [95% CI: - 5.83 - -4.22]), HIV (B -2.89 [95% CI: - 4.44 - -1.34]),MUAC (B 0.86 [95% CI: 0.52-1.21]), and age (B 0.09 [95% CI: 0.07-0.12]). CONCLUSION: The micronutrient levels of visceral leishmaniasis patients were significantly lower. The anti-leishmaniasis treatment did not increase the serum micronutrient level of the patients.

Performance of two immunochromatographic tests for diagnosis of visceral leishmaniasis in patients coinfected with HIV.

Because of visceral leishmaniasis (VL) urbanization and spreading of the human immunodeficiency virus (HIV) infection to rural areas, coinfection has become more common. Here, we compared the accuracy of Kalazar Detect® (KD), an rK39-based immunochromatographic (IC) test, and OrangeLife® (OL), an rK39 + rK28 IC test, for diagnosing VL in patients coinfected with HIV in an endemic area in Brazil. Seventy-six VL patients and 40 patients with other diseases, of which 31 and 21 patients, respectively, were infected with HIV, were examined. The sensitivity of OL and KD tests was 88.89 and 95.45%, respectively, in patients without HIV. The sensitivity dropped to 67.74 and 61.29%, respectively, in coinfected patients. The decrease in sensitivity was not related to a decrease in the production of Leishmania-specific IgG. Because of the low sensitivity of rk39 test in HIV-infected patients, we suggest that patients with negative rK39 results should undergo further investigation with additional serological tests that are not based only on the rK39 antigen and examination of bone marrow aspirates.

Role of Haematological Changes in Predicting Occurrence of Leishmaniasis- A Study in Kumaon Region of Uttarakhand.

INTRODUCTION: A number of cases of Leishmaniasis have been reported from non-endemic sub-himalayan regions of India. Due to low clinical suspicion and atypical presentation, cases may go undetected or there may be a delay in diagnosis. AIM: The aim of the study was to evaluate clinico-haematological parameters and bone marrow findings so that a high degree of suspicion could be made in unsuspected cases of Visceral Leishmaniasis (VL) and Leishman Donovan (LD) body negative bone marrow smears. MATERIALS AND METHODS: A retrospective study was conducted at a tertiary care centre serving the kumaon region of Uttarakhand from 2010 to 2014. Forty bone marrow aspirates were included, which were sent on clinical suspicion of VL. Twenty cases were positive for LD bodies. Their clinico-haematological features including bone marrow findings were studied in detail and compared with rest of the 20 LD negative cases. Five LD negative cases were also positive for rk39. RESULTS: Twenty LD positive cases were evaluated. Splenomegaly was the most common sign present in 17 cases (85%). Anaemia, leucopenia and lymphocytosis were present in all the cases (100%). Pancytopenia was seen in 17 cases (85%). Microcytic hypochromic blood picture was the most common finding in 11 cases (55%). Bone marrow was normocellular in 7 cases (35%), hypercellular in 7 cases (35%). Erythropoesis was micro-normoblastic in 11 cases (55%). Overall, there were 25 cases of VL (20 LD positive, 5 LD negative). Increased plasma cells, lymphocytes and histiocytes were seen in 17 cases (68%) of VL. CONCLUSION: In non-endemic region where clinical suspicion is low, bone marrow findings can be a strong indicator for VL even though marrow is negative for LD bodies. If required other ancillary investigations can also be ordered. This study also emphasizes the need for epidemiological work up in this region.

Leishmaniose visceral no estado do Pará / Visceral leishmaniasis in Pará state

OBJETIVO: descrever o perfil epidemiológico dos casos notificados de Leishmaniose Visceral (LV), no estado do Pará, de janeiro de 2007 a dezembro de 2011. MÉTODO: estudo transversal, de dados estatísticos e epidemiológicos fornecidos pelo Grupo de Trabalho Leishmanioses, da Secretaria de Estado de Saúde Pública do Pará. Como a LV não é uma doença endêmica em todos os municípios do estado, a pesquisa abordou os casos das regionais municipais com maior prevalência da doença e/ou aquelas, nas quais estão localizados municípios de transmissão intensa no Pará. Para as informações obtidas realizaram-se cálculos de frequências e médias utilizando-se os programas Microsoft Office Excel® 2007, Word® 2007 e BioEstat® 5.0. RESULTADOS: nas treze regionais de saúde do estado foram registrados 1.877 casos no período do estudo, com os maiores números de casos pertencentes à 6ª. Regional (24,3%) e à 2ª. Regional (22,1%). A proporção de casos no ano de 2007 foi de 24,2%, e de 17,4% em 2011. As oito regionais definidas para este estudo registraram 1.738 casos, no total. Nestas, a faixa etária de 1 a 9 anos de idade teve o maior número de casos (57,3%), assim como, o sexo masculino (59,6%). Junho foi o mês com maior frequência de doentes (12,0%) e 68,4% do total ocorreram na zona rural. O exame parasitológico foi positivo em 25,7% dos casos, assim como, 72,3% foram positivos para a reação de imunofluorescência indireta. Com relação à classificação dos casos, 91,8% foram casos novos e 2,5% recidiva da doença; evoluíram para a cura 64,5% do grupo e a taxa de letalidade foi de 3,9%. O critério laboratorial confirmou 88,8% dos casos; a autoctonia foi registrada em uma proporção de 86,1%. Com relação ao quadro clínico, a febre foi a manifestação mais frequente em 92,4% dos participantes. Em 76,9% dos casos, a droga mais utilizada foi o Antimonial Pentavalente. CONSIDERAÇÕES FINAIS: o estudo demonstrou maior prevalência da doença em crianças, homens e nos residentes em zona rural. Embora com letalidade baixa, constatou-se ainda a expressiva frequência da Leishmaniose Visceral no Estado do Pará, apesar da queda do número de casos durante os anos do estudo.

OBJECTIVE: To delineate the epidemiology of reported cases of visceral leishmaniasis in the state of Pará, from January 2007 to December 2011. METHOD: A descriptive transversal study, statistical and epidemiological data provided by the Working Group Leishmaniasis, the State Department of Public Health Pará. The study addressed the cases of eight health districts of the state of Pará. Calculations of frequencies and averages using the programs Microsoft Office Excel ® 2007, Microsoft ® Office Word 2007 and BioEstat ® 5.0. RESULTS: analyzed the information of 1,738 cases of visceral leishmaniasis, with most cases (24.3%) belonging to the 6th Regional Health, the age group 1-9 years of age (57.3%) and males (59.6%). June was the month with the highest frequency of cases (12.0%), the countryside the most frequent (68.4%). In the total study population parasitological examination was positive in 25.7% of cases, as well as 72.3% were positive for indirect immunofluorescence. Regarding the classification of cases, 91.8% were new cases, 2.5% disease recurrence; healing progressed with 64.5% of the group and the fatality rate was 3.9%. The most commonly used drug was pentavalent antimony (76.9%). The laboratory test confirmed 88.8% of cases; autochthony was recorded in 86.1% of cases. With regard to the clinical, fever was the most common manifestation (92.4%). CONCLUSION: This study showed the prevalence of the disease in children, and men living in rural areas. Although with low mortality, there was still a significant frequency Visceral Leishmaniasis in the State of Pará, despite the decline in the absolute number of cases over the years.

Risk factors for Leishmania chagasi infection in an endemic area in Raposa, State of Maranhão, Brazil / Fatores associados à infecção por Leishmania chagasi em uma área endêmica em Raposa, Estado do Maranhão, Brasil

INTRODUCTION: Infection with Leishmania chagasi is the most common clinical presentation for visceral leishmaniaisis in endemic areas. The municipality of Raposa is an endemic area in State of Maranhão, Brazil, and have had registration cases of visceral leishmaniasis disease. For this reason, a cross- sectional study was conducted to evaluate the risk factors for infection with L. chagasi detected by Montenegro skin test. METHODS: The sample comprised 96 percent of the inhabitants of the villages of Maresia, Pantoja, and Marisol located in the municipality of Raposa, corresponding to 1,359 subjects. Data were collected using a questionnaire. Univariate and multivariate logistic regression models were applied to evaluate the association between the variables studied and infection of L. chagasi. RESULTS: The variables associated with infection upon nonadjusted analysis were a straw roof, mud walls, floors of beaten earth, presence of sand flies inside or outside of the dwelling, and bathing outdoors. Adjusted analysis showed that the presence of sand flies inside/outside the dwelling was a risk factor, and age younger than 10 years was a protective factor against asymptomatic infection. CONCLUSIONS: The results highlight the extent to which precarious living conditions of the population strengthen the epidemiological chain of visceral leishmaniasis.

INTRODUÇÃO: A infecção por Leishmania chagasi é a apresentação clínica mais comum de laishmaniose visceral em áreas endêmicas. O município de Raposa é área endêmica no Estado do Maranhão, tendo registrado casos da doença. Por isso, realizou-se um estudo transversal, com o objetivo de estudar os fatores de risco para infecção por L. chagasi detectada pelo teste intradérmico de Montenegro. MÉTODOS: O estudo envolveu 96 por cento dos moradores das localidades de Maresia, Pantoja e Marisol do município da Raposa, totalizando 1.359 indivíduos. O levantamento dos dados foi realizado utilizando um questionário. Para verificar a associação entre as variáveis estudadas e a infecção por L. chagasi, foram utilizados os modelos de regressão logística uni e multivariada. RESULTADOS: Na análise não ajustada, as variáveis associadas à infecção foram: cobertura da casa de palha, paredes de taipa, piso de chão batido, a presença de flebotomíneos dentro ou fora do domicílio e o local do banho fora de casa. Na análise ajustada, a presença de flebotomíneos dentro ou fora do domicílio foi considerada fator de risco e a idade menor que 10 anos revelou-se como fator de proteção para a infecção assintomática. CONCLUSÕES: Evidenciou-se também, o quanto a precariedade das condições de vida da população contribui para o fortalecimento da cadeia epidemiológica da doença.

Leishmaniasis cutánea asociada a síndrome antifosfolipídico / Cutaneous leishmaniasis associated to antiphospholipid syndrome

Presentamos el caso de un paciente masculino de 24 años, con diagnóstico de leishmaniasis cutánea, que muestra cuadro clínico caracterizado por lesiones ulcerosas, de bordes definidos, edematoso y eritematoso en brazo derecho y párpado superior de ojo izquierdo, acompañado de dolor intenso en el mismo miembro, documentándose por ecografía y flebografía trombo en el nivel de la vena basílica en el brazo derecho. Se diagnostica trombosis venosa y se solicitan anticuerpos anticardiolipinas, los cuales reportan positivos, llegando a la conclusión de que el paciente es portador de un síndrome antifosfolipídico secundario, siendo esta asociación poco frecuente.

We present a 24 years old male patient, with diagnosis of cutaneous leishmaniasis, characterized by clinical erythematous, edematous and ulcerating lesions of well defined edges, in his right arm and upper left eyelid, accompanied by intense pain at the same extremity; a thrombus was documented by ultrasound and phlebography at the basilica vein in his right arm. It was diagnosed venous thrombosis and the anticardiolipin-antibodies was reported was positive. We made the diagnosis of secondary antiphospholipid syndrome secondary, being this a rare association.

Alteraciones hepáticas en la Leishmaniasis Visceral (Kalazar) en niños: revisión sistemática de la literatura / Liver injury in visceral Leishmaniasis in Children: systematic review

La Leishmaniasis Visceral o Kalazar es una infección parasitaria causada por subespecies del género Leishmania donovani y transmitida por insectos flebotomíneos. Puede evolucionar con compromiso hepático caracterizado por citólisis severa, colestasis, hipertensión portal, hepatomegalia persistente y fibrosis hepática. Estos tipos de presentaciones dificultan el diagnóstico y agravan el pronostico. Se admite que la extensión y frecuencia de este compromiso hepático han sido poco evaluados. Objetivo: Sistematizar las alteraciones hepáticas de Kalazar en la infancia descritas en relatos de casos publicados. Metodología: revisión sistemática de la literatura utilizando las bases de datos LILACS, MEDLINE y EMBASE. Se incluyeron artículos en portugués, español, inglés y francés. Se siguieron los procedimientos de revisión sistemática recomendados por el NHS Centre for Reviews and Dissemination, University of Cork. La clasificación de los artículos (relatos de casos) se basó en la cantidad de información de cada relato de caso en relación a las variables previamente sistematizadas en este estudio. Resultados: 11 (un 55%) artículos fueron incluidos abarcando 28 relatos de casos. La albúmina sérica y el tiempo de protrombina mostraron una asociación con la evolución de la enfermedad: (p = 0,05). Conclusiones: el compromiso epático, incluso grave, puede ocurrir al inicio de la enfermedad. El Kalazar debe ser considerado en el diagnóstico diferencial de hepatitis asociadas a fiebre prolongada, así como en síndromes colestásicos en la infancia en áreas endémicas para la enfermedad.

Visceral Leisshimaniosis or Kalazar is a parasitic infection caused by Leishimania Donovani subspecies. It is transmitted by phlebotomineos and may lead to liver and spleen enlargements as well as immunological impairment. Sometimes it is described liver injury simulating acute or chronic viral hepatitis and even portal hypertension. The liver injury makes difficult the diffencial diagnosis of Kalazar and other liver diseases in endemic regions. Objective: To define and clarify the liver injury spectrum described in published cases reports. Methods: Systematic revision of published data on Kalazar and liver injury, using the following databank: LILACS, MEDLINE and EMBASE. Only paper published in French, English, Portuguese and Spanish were taken into consideration. The procedures for systematic review recommended by the NHS Centre for Reviews and Dissemination, University of Cork, were adopted. The paper quality classification was based on the number of reported variables previously defined in our study. Results: Only 11/ 28 (55%) publications were includedin our analysis because they filled the minimal required data. Acute and chronic liver disease were well documented in these articles. Serum albumin and prothombine time were associated with severity of liver disease (P< .05). Conclusion: “Liver involvement, even when it is severe, may occur at tha begining of the disease. Kalazar should be considered as a differential diagnosis of cholestasis, acute and chronic liver injury, as well as portal hypertension in children.