Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil.

INTRODUCTION: Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host's nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels. METHODS: This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level. RESULTS: Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables. CONCLUSIONS: Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.

Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil

Abstract INTRODUCTION: Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host's nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels. METHODS: This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level. RESULTS: Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables. CONCLUSIONS: Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.

Severe Kala-azar and seric level of IL-6: case reports / Calazar grave e níveis séricos de IL-6: relato de casos

Introduction: IL-6 is a cytokine that participates in the systemic inflammatory process in Kala-azar, its plasma levels are high during active disease and especially in patients with severe clinical condition. Case reports: Three patients from different age groups, clinical score of severe disease and different plasma levels of IL-6 were reported. Conclusion: The results suggest that only the clinical severity score does not present sensitivity to classify, among critically ill patients, those with imminent risk of death. The IL-6 concentration seems to allow this differentiation, considering that the only fatal case, HBV/Leishmania coinfection, presented an expressively higher plasma level.

Introdução: IL-6 é uma citocina que participa do processo inflamatório sistêmico no calazar. Seus níveis plasmáticos estão elevados durante doença ativa e, principalmente, em pacientes com quadro clínico grave. Relato de casos: foram reportados três pacientes em diferentes faixas etárias, escore clínico de doença grave e diferentes níveis plasmáticos de IL-6. Conclusão: os resultados sugerem que apenas o escore clínico não apresenta sensibilidade para classificar, entre os doentes graves, aquele com risco iminente de óbito. A concentração de IL-6 parece permitir essa diferenciação, considerando que o único caso fatal, coinfecção HBV/Leishmania, mostrou nível plasmático expressivamente mais elevado.