title: Bone marrow parasite burden among patients with New World kala-azar is associated with disease severity.
abstract: Kala-azar or visceral leishmaniasis, found mostly throughout the Indian Subcontinent, East Africa, and Brazil, kills 20,000-40,000 persons annually. The agents, Leishmania donovani and Leishmania infantum, are obligatory intracellular protozoa of mononuclear phagocytes found principally in the spleen and bone marrow. Protracted fever, anemia, wasting, hepatosplenomegaly, hemorrhages, and bacterial co-infections are typical features. One hundred and twenty-two (122) in-hospital patients were studied to verify if higher bone marrow parasite load estimated by quantitative polymerase chain reaction is associated with severe disease. The estimated median parasite load was 5.0 parasites/10(6) human nucleated cells. It is much higher in deceased than among survivors (median 75.0 versus 4.2). Patients who lost more weight had a higher parasite burden, as well as patients with epistaxis, abdominal pain, edema, and jaundice. This study suggests that higher parasite load is influenced by wasting, which may lead to more severe disease.
authors.affiliation: Laboratory of Leishmaniasis, Institute of Tropical Diseases "Natan Portella", Federal University of Piauí, Teresina, PI, Brazil; Department of Biology, Federal University of Piauí, Floriano at Floriano, PI, Brazil; Maternal and Childhood Department, Federal University of Piauí, Teresina, PI, Brazil; Laboratory of Molecular Biology, Nucleus of Tropical Medicine, Federal University of Pará, Belém, PA, Brazil; Department of Community Medicine, Federal University of Piauí, Teresina, PI, Brazil.
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Silva
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Zacarias
authors.forename: Lívio C
authors.initials: LC
authors.lastname: de Figueirêdo
authors.forename: Maria Regiane A
authors.initials: MR
authors.lastname: Soares
authors.forename: Edna A Y
authors.initials: EA
authors.lastname: Ishikawa
authors.forename: Dorcas L
authors.initials: DL
authors.lastname: Costa
authors.forename: Carlos H N
authors.initials: CH
authors.lastname: Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D001853:Bone Marrow / Q000469:parasitology*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018105:DNA, Kinetoplast / Q000032:analysis*; D005260:Female; D006801:Humans; D007223:Infant; D007893:Leishmania donovani / Q000235:genetics* / Q000302:isolation & purification; D018314:Leishmania infantum / Q000235:genetics* / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000469:parasitology*; D008297:Male; D059208:Parasite Load; D016133:Polymerase Chain Reaction; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D018105:DNA, Kinetoplast