Lipid derangement as diagnostic and prognostic indicator for visceral leishmaniasis patients.

Sir,

Visceral leishmaniasis popularly known as Kala-azar, is caused by an intracellular protozoa Leishmania donovani (LD). Fever, hepatosplenomegaly and weight loss are the common presenting features of the disease. Anemia, leukopenia, thrombocytopenia and hyperglobulinemia with alteration of albumin: globulin (A:G) ratio are some of the most common laboratory finding observed in this condition. In India, more than 50% of Kala-azar cases are reported form Bihar.[1] Bone marrow aspiration is the gold standard for diagnosis of visceral leishmaniasis. However, it is a painful procedure, needs expertise and difficult to interpret in low parasitemic conditions. Currently, immunochromatographic test (ICT) coating rk39 recombinant kinesin antigen has become more popular for the diagnosis of Kala-azar.[2] It shows high sensitivity and specificity for the diagnosis of Kala-azar, however has limited role in the disease prognosis.[2] Plasma lipid profile alterations such as hypocholesteraemia, increased triglyceridemia are previously reported in few cases of visceral leishmaniasis.[345] However none of them had correlated the above parameters as a diagnostic and prognostic adjunct with that of the established clinical and hematological parameters. Here, we would like to point out these metabolic alterations in nine visceral leismaniasis patients, which might give a clue for the best markers as the diagnostic and prognostic indicator for visceral leishmaniasis cases.

A total nine clinically diagnosed Kala-azar patients were investigated for their lipid profile before the start of treatment. Total serum cholesterol, high density cholesterol, low density lipoprotein, very low density lipoprotein (VLDL) and triglyceride levels were determined. Detail clinical and hematological parameters of these cases were analyzed [Table 1]. Fever with hepatosplenomegaly remained the chief complaints in all patients. Among the hematological parameters anemia and leukopenia were the most constant hematological parameters present in (89%) of cases followed by thrombocytopenia. Five out of nine patients (56%) were residents of Bihar. LD bodies in bone marrow aspirate were confirmed in two out of five patients. All the samples were positive for rk39 ICT (InBios Ltd.). 7/9 patients showed altered A: G ratio. Increased triglyceride level was found to be the most common lipid derangement among 7/9 (78%) cases followed by increased VLDL in 5/9. During our observation, hypocholesterolemia was found only in 3/9 (33%) of patients which was reported earlier.[4] All the patients were treated with injection Amphotericin B (IV infusion of 0.75-1 mg/Kg for 15-20 days alternate). Four cases could be followed-up after completion of treatment. All the clinical, hematological and plasma lipid profile were reviewed on the day of completion of the treatment [Table 2]. 3/4 patients showed normal hematological parameters after the completion of treatment. Among all the lipid profiles, triglyceride level was observed to become normal in all the 4 patients (100%). The alteration of lipid parameters especially triglyceride was significant even in bone marrow aspirate negative patients. We consider in visceral leishmniasis patients, along with the clinical and hematological parameters, triglyceride level (before and after the treatment) will give a better clue for diagnosis and prognosis of these patients.

Table 1

Variations of lipid profile with clinical and hematological parameters in visceral leishmaniasis patients

Table 2

Lipid profile in visceral leishmaniasis patients