title: The epidemiology of visceral leishmaniasis and asymptomatic leishmanial infection in a highly endemic Bangladeshi village.
abstract: We examined the epidemiology of kala-azar and asymptomatic leishmanial infection measured by serologic and leishmanin skin test results in a Bangladeshi community. In a subset, we measured serum retinol, zinc and C-reactive protein (CRP). Kala-azar and seroconversion incidence were 15.6 and 63.1 per 1,000 person-years, respectively. Proximity to a previous kala-azar case increased the likelihood of both kala-azar and asymptomatic infection. Bed net use protected against kala-azar (rate ratio = 0.35, P < 0.01), but not subclinical infection (rate ratio = 1.1, P = 0.82). Kala-azar patients were younger (P < 0.001) and reported lower red meat consumption (P < 0.01) than asymptomatic seropositive individuals. Retinol and zinc levels were lower in current kala-azar patients and those who later developed kala-azar compared with uninfected and asymptomatically infected subjects. The CRP levels were higher in kala-azar patients compared with the other two groups. Low red meat intake and poor zinc and retinol status may characterize a group at higher risk of symptomatic disease.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. CBern@cdc.gov
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
authors.forename: Rashidul
authors.initials: R
authors.lastname: Haque
authors.forename: Rajib
authors.initials: R
authors.lastname: Chowdhury
authors.forename: Mustakim
authors.initials: M
authors.lastname: Ali
authors.forename: Katie M
authors.initials: KM
authors.lastname: Kurkjian
authors.forename: Louise
authors.initials: L
authors.lastname: Vaz
authors.forename: Josef
authors.initials: J
authors.lastname: Amann
authors.forename: M A
authors.initials: MA
authors.lastname: Wahed
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Wagatsuma
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: John
authors.initials: J
authors.lastname: Williamson
authors.forename: W Evan
authors.initials: WE
authors.lastname: Secor
authors.forename: James H
authors.initials: JH
authors.lastname: Maguire
mesh_terms: D000328:Adult; D000913:Antibodies, Protozoan / Q000032:analysis / Q000378:metabolism; D000953:Antigens, Protozoan / Q000378:metabolism; D001459:Bangladesh / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D016012:Poisson Distribution; D015995:Prevalence; D015800:Protozoan Proteins / Q000378:metabolism; D012307:Risk Factors; D013997:Time Factors; D014801:Vitamin A / Q000097:blood; D015032:Zinc / Q000097:blood
chemical_list: D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D015800:Protozoan Proteins; D014801:Vitamin A; D002097:C-Reactive Protein; C079253:K39 antigen, Leishmania; D015032:Zinc