INTRODUCTION: The objective of the study is to identify the main risk factors for death by New World visceral leishmaniasis and establish a coherent pathogenic substrate of severe disease based on clinical findings. METHODS: Seventy-six deceased inpatients and 320 successfully treated inpatients with VL were studied in a case control study. RESULTS: Bacterial infection and bleeding were mutually exclusive events leading to death. Five risk factors were unique for death by bacterial infection (malnutrition, pulmonary rales, severe anemia, severe absolute neutropenia and higher neutrophil count), while another six were unique for death by bleeding (jaundice, severe relative neutropenia, severe thrombocytopenia, liver injury, kidney failure, higher bone marrow parasite load). Bacterial infection, bleeding, severe anemia, diarrhea, dyspnea, edema, jaundice and bone marrow parasite load were the main syndromes of visceral leishmaniasis among successfully treated patients. CONCLUSIONS: The data support the idea that bacterial infections are due to immune paralysis. Broad organ and system involvement is plausibly due to the high production of proinflammatory cytokines, whose actions fit well with visceral leishmaniasis. The syndromes and causative mediators are typical of a slowly developing systemic inflammatory response syndrome.
INTRODUCTION: The objective of the study is to identify the main risk factors for death by New World visceral leishmaniasis and establish a coherent pathogenic substrate of severe disease based on clinical findings. METHODS: Seventy-six deceased inpatients and 320 successfully treated inpatients with VL were studied in a case control study. RESULTS: Bacterial infection and bleeding were mutually exclusive events leading to death. Five risk factors were unique for death by bacterial infection (malnutrition, pulmonary rales, severe anemia, severe absolute neutropenia and higher neutrophil count), while another six were unique for death by bleeding (jaundice, severe relative neutropenia, severe thrombocytopenia, liver injury, kidney failure, higher bone marrow parasite load). Bacterial infection, bleeding, severe anemia, diarrhea, dyspnea, edema, jaundice and bone marrow parasite load were the main syndromes of visceral leishmaniasis among successfully treated patients. CONCLUSIONS: The data support the idea that bacterial infections are due to immune paralysis. Broad organ and system involvement is plausibly due to the high production of proinflammatory cytokines, whose actions fit well with visceral leishmaniasis. The syndromes and causative mediators are typical of a slowly developing systemic inflammatory response syndrome.
Authors: Joyce M Silva; Danielle A Zacarias; Lívio C de Figueirêdo; Maria Regiane A Soares; Edna A Y Ishikawa; Dorcas L Costa; Carlos H N Costa Journal: Am J Trop Med Hyg Date: 2014-03-10 Impact factor: 2.345
Authors: Michelle J C Oliveira; Geraldo B Silva; Aline M Sampaio; Bárbara L Montenegro; Marília P Alves; Guilherme A L Henn; Hermano A L Rocha; Gdayllon C Meneses; Alice M C Martins; Elizabeth F Daher Journal: Am J Trop Med Hyg Date: 2014-08-11 Impact factor: 2.345
Authors: Dorcas L Costa; Regina L Rocha; Rayssa M A Carvalho; Adelino S Lima-Neto; Michael O Harhay; Carlos Henrique N Costa; Manoel Barral-Neto; Aldina P Barral Journal: Pathog Glob Health Date: 2013-03 Impact factor: 2.894
Authors: Priscila L Dos Santos; Fabrícia A de Oliveira; Micheli Luize B Santos; Luana Celina S Cunha; Michelle T B Lino; Michelle F S de Oliveira; Manuela O M Bomfim; Angela Maria Silva; Tatiana R de Moura; Amélia R de Jesus; Malcolm S Duthie; Steven G Reed; Roque P de Almeida Journal: PLoS Negl Trop Dis Date: 2016-01-27
Authors: Geraldine Madalosso; Carlos Magno Fortaleza; Ana Freitas Ribeiro; Lisete Lage Cruz; Péricles Alves Nogueira; José Angelo Lauletta Lindoso Journal: J Trop Med Date: 2012-09-13