title: Parasite load and risk factors for poor outcome among children with visceral leishmaniasis. A cohort study in Belo Horizonte, Brazil, 2010-2011.
abstract: Clinical and laboratory risk factors for death from visceral leishmaniasis (VL) are relatively known, but quantitative real-time polymerase chain reaction (qPCR) might assess the role of parasite load in determining clinical outcome. The aim of this study was to identify risk factors, including parasite load in peripheral blood, for VL poor outcome among children. This prospective cohort study evaluated children aged ≤ 12 years old with VL diagnosis at three times: pre-treatment (T0), during treatment (T1) and post-treatment (T2). Forty-eight patients were included and 16 (33.3%) met the criteria for poor outcome. Age ≤ 12 months [relative risk (RR) 3.51; 95% confidence interval (CI) 1.89-6.52], tachydyspnoea (RR 3.46; 95% CI 2.19-5.47), bacterial infection (RR 3.08; 95% CI 1.27-7.48), liver enlargement (RR 3.00; 95% CI 1.44-6.23) and low serum albumin (RR 7.00; 95% CI 1.80-27.24) were identified as risk factors. qPCR was positive in all patients at T0 and the parasite DNA was undetectable in 76.1% of them at T1 and in 90.7% at T2. There was no statistical association between parasite load at T0 and poor outcome.
authors.affiliation: Hospital Infantil João Paulo  II, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG, Brasil.
authors.forename: Maria Vitória Assumpção
authors.initials: MV
authors.lastname: Mourão
authors.affiliation: Serviço Multiprofissional de Infectologia, Universidade José do Rosário Vellano-UNIFENAS, Belo Horizonte, MG, Brasil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Toledo
authors.affiliation: Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou-Fiocruz, Belo Horizonte, MG, Brasil.
authors.forename: Luciana Inácia
authors.initials: LI
authors.lastname: Gomes
authors.affiliation: Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou-Fiocruz, Belo Horizonte, MG, Brasil.
authors.forename: Verônica Vieira
authors.initials: VV
authors.lastname: Freire
authors.affiliation: Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou-Fiocruz, Belo Horizonte, MG, Brasil.
authors.forename: Ana
authors.initials: A
authors.lastname: Rabello
mesh_terms: D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000302:isolation & purification; D004417:Dyspnea / Q000175:diagnosis; D005260:Female; D006529:Hepatomegaly; D006801:Humans; D007891:Leishmania / Q000235:genetics / Q000302:isolation & purification*; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology*; D008099:Liver / Q000469:parasitology; D008297:Male; D017063:Outcome Assessment, Health Care / Q000592:standards*; D059208:Parasite Load / Q000706:statistics & numerical data*; D016133:Polymerase Chain Reaction / Q000592:standards; D011446:Prospective Studies; D012335:RNA, Ribosomal / Q000097:blood; D012307:Risk Factors; D012709:Serum Albumin; D013154:Spleen / Q000469:parasitology; D018709:Statistics, Nonparametric
chemical_list: D016054:DNA, Protozoan; D012335:RNA, Ribosomal; D012709:Serum Albumin