title: Subclinical form of the American visceral leishmaniasis.
abstract: The subclinical form of visceral leishmaniasis (VL) shows nonspecific clinical manifestations, with difficulties being frequently met in its clinical characterization and diagnostic confirmation. Thus, the objective of the present study was to define the clinical-laboratory profile of this clinical form. A cohort study was conducted in the state of Maranhão, Brazil, from January/1998 to December/2000, with monthly follow-up of 784 children aged 0-5 years. Based on the clinical-laboratory parameters reported in the literature, four categories were established, with the children being classified (according to their clinical-evolutive behavior) as asymptomatic (N = 144), as having the subclinical form (N = 33) or the acute form (N = 12) or as subjects "without VL" (N = 595). Multiple discriminant analysis demonstrated that the combination of fever, hepatomegaly, hyperglobulinemia, and increased blood sedimentation rate (BSR) can predict the subclinical form of VL as long as it is not associated with splenomegaly or leukopenia. Subjects with the subclinical form did not show prolonged or intermittent evolution or progression to the acute form of VL. Subclinical cases have a profile differing from the remaining clinical forms of VL, being best characterized by the combination of fever, hepatomegaly, hyperglobulinemia, and increased BSR.
authors.affiliation: Departamento de Medicina III (Pediatria), Universidade Federal do Maranhão, Praça Gonçalves Dias 21 ILA, 65020-270 São Luis, MA, Brazil. mgama@elo.com.br
authors.forename: Mônica Elinor Alves
authors.initials: ME
authors.lastname: Gama
authors.forename: Jackson Maurício Lopes
authors.initials: JM
authors.lastname: Costa
authors.forename: Cláudia Maria Castro
authors.initials: CM
authors.lastname: Gomes
authors.forename: Carlos Eduardo Pereira
authors.initials: CE
authors.lastname: Corbett
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D000953:Antigens, Protozoan / Q000097:blood*; D002675:Child, Preschool; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007891:Leishmania / Q000276:immunology*; D007898:Leishmaniasis, Visceral / Q000097:blood / Q000175:diagnosis*
chemical_list: D000953:Antigens, Protozoan