Abstract
Clinical and laboratory risk factors for death from visceral leishmaniasis (VL) are relatively known, but quantitative real-time polymerase chain reaction (qPCR) might assess the role of parasite load in determining clinical outcome. The aim of this study was to identify risk factors, including parasite load in peripheral blood, for VL poor outcome among children. This prospective cohort study evaluated children aged ≤ 12 years old with VL diagnosis at three times: pre-treatment (T0), during treatment (T1) and post-treatment (T2). Forty-eight patients were included and 16 (33.3%) met the criteria for poor outcome. Age ≤ 12 months [relative risk (RR) 3.51; 95% confidence interval (CI) 1.89-6.52], tachydyspnoea (RR 3.46; 95% CI 2.19-5.47), bacterial infection (RR 3.08; 95% CI 1.27-7.48), liver enlargement (RR 3.00; 95% CI 1.44-6.23) and low serum albumin (RR 7.00; 95% CI 1.80-27.24) were identified as risk factors. qPCR was positive in all patients at T0 and the parasite DNA was undetectable in 76.1% of them at T1 and in 90.7% at T2. There was no statistical association between parasite load at T0 and poor outcome.
Highlights
Belo Horizonte, the capital of the state of Minas Gerais, an endemic region for visceral leishmaniasis (VL), showed an increase in VL cases, with an annual average of 83 cases per year between 2000-2004 and 132 cases per year between 2005-2010
The objective of this study was to identify risk factors, including parasite load quantified by Quantitative real-time polymerase chain reaction (qPCR) in the peripheral blood, for VL poor outcome among children
Association between demographic, clinical and laboratory findings and poor outcome in children with visceral leishmaniasis hospitalised at João Paulo II Hospital, June 2010-June 2011
Summary
Belo Horizonte, the capital of the state of Minas Gerais, an endemic region for VL, showed an increase in VL cases, with an annual average of 83 cases per year between 2000-2004 and 132 cases per year between 2005-2010. Two studies assessed the association between pre-treatment parasite counts and VL outcome These studies, from Sudan and Brazil, showed that higher number of parasites in the spleen or bone marrow (BM) were associated with a higher death rate (Seaman et al 1996, Costa et al 2010). Quantitative real-time polymerase chain reaction (qPCR) is a technique that can quantify parasite load in an accurate manner in different biological samples, including peripheral blood It provides results more rapidly than microscopic techniques, with less DNA contamination and fewer false positive results than standard PCR (Kubista et al 2006). All patients with confirmed VL in the study period were invited to participate the study
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