Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study

Carlos Henrique Nery Costa,Aline Santos Carvalho,Loryenne Santos Santos,Dorcas Lamounier Costa,Janaína Costa Cavalcanti,Guilherme Brasileiro Aguiar,Guilherme Loureiro Werneck,Thiago Ayres Holanda

doi:10.1590/s0037-86822010000400010

Abstract

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. Seventy-six deceased inpatients and 320 successfully treated inpatients with VL were studied in a case control study. 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. 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.

Highlights

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
The organisms are obligate intracellular protozoa, mostly found in the spleen, bone marrow, liver and lymph nodes, and the disease is transmitted by sand flies
The records of deceased patients with Visceral leishmaniasis (VL) were independently reviewed by two observers to determine the causes of death

Summary

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. 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. Visceral leishmaniasis (VL), or kala-azar, is a parasitic disease endemic to many temperate and tropical countries.

Objectives

Methods

Results