Causes and consequences of higher Leishmania infantum burden in patients with kala‐azar: a study of 625 patients
Adult
Male
Adolescent
Nutritional Status
HIV Infections
Parasitemia
Severity of Illness Index
03 medical and health sciences
0302 clinical medicine
Humans
Leishmania infantum
Child
2. Zero hunger
DNA, Kinetoplast
Malnutrition
Age Factors
Infant
Middle Aged
3. Good health
Child, Preschool
Leishmaniasis, Visceral
Female
Brazil
Leishmania donovani
DOI:
10.1111/tmi.12877
Publication Date:
2017-04-05T22:25:31Z
AUTHORS (8)
ABSTRACT
AbstractBackgroundAn infected host's Leishmania infantum load in blood is considered to be an estimate of his or her total parasite burden. Therefore, the measurement of blood parasite burden is important in the identification of factors involved in parasite control.MethodsQuantitative polymerase chain reaction was performed on blood samples from 625 patients with kala‐azar consecutively admitted to a reference hospital in Teresina, Brazil. Primers were used to amplify a segment of kDNA using the TaqMan system. Non‐parametric statistical tests were applied.ResultsThe median blood parasite burden was 499.2 amastigote equivalents (AE)/ml. Children <1 year old (yo) had a high parasite burden, which dropped sharply after the first year of life (192.8, AE/ml at 1 < 2 yo) and remained lower until adolescence. Following adolescence, the parasite burden increased with age, peaking among elderly individuals. Men had a higher parasite burden than women. HIV‐infected patients had a much higher parasite burden than non‐infected patients. The parasite burden of children under 5 years with acute moderate to severe malnourishment (weight‐for‐age and body mass index z‐scores <−2) was almost three times greater than that of better‐nourished children. The parasite burden identified in deceased patients was more than twice that of surviving patients; those with a higher risk of death, sepsis, pneumonia and jaundice also had increased parasite burdens. All of these differences were statistically significant at P‐values <0.05.ConclusionsThese data indicate that the parasite burden in patients with kala‐azar was associated with age‐ and gender‐associated factors and with HIV infection status. Acute malnutrition could be either a cause or a consequence of a higher parasite burden. An individual's parasite burden influences his or her clinical profile, disease severity and mortality risk. The best explanation for the presence of a higher parasite burden in individuals with these immunoregulatory conditions and severe disease is the occurrence of acquired immunosuppression followed by heightened innate immunity.
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