The epidemiology of visceral leishmaniasis and asymptomatic leishmanial infection in a highly endemic Bangladeshi village.
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.
Bern
Caryn
C
Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. CBern@cdc.gov
Haque
Rashidul
R
Chowdhury
Rajib
R
Ali
Mustakim
M
Kurkjian
Katie M
KM
Vaz
Louise
L
Amann
Josef
J
Wahed
M A
MA
Wagatsuma
Yukiko
Y
Breiman
Robert F
RF
Williamson
John
J
Secor
W Evan
WE
Maguire
James H
JH
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
D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D015800:Protozoan Proteins; D014801:Vitamin A; D002097:C-Reactive Protein; C079253:K39 antigen, Leishmania; D015032:Zinc