title: Chronic Arsenic Exposure and Risk of Post Kala-azar Dermal Leishmaniasis Development in India: A Retrospective Cohort Study.
abstract: BACKGROUND
  Visceral leishmaniasis (VL), with the squeal of Post-kala-azar dermal leishmaniasis (PKDL), is a global threat for health. Studies have shown sodium stibogluconate (SSG) resistance in VL patients with chronic arsenic exposure. Here, we assessed the association between arsenic exposure and risk of developing PKDL in treated VL patients.
  
  
  METHODS
  In this retrospective study, PKDL patients (n = 139), earlier treated with SSG or any other drug during VL, were selected from the study cohort. Trained physicians, unaware of arsenic exposure, interviewed them and collected relevant data in a questionnaire format. All probable water sources were identified around the patient's house and water was collected for evaluation of arsenic concentration. A GIS-based village-level digital database of PKDL cases and arsenic concentration in groundwater was developed and individual point location of PKDL cases were overlaid on an integrated GIS map. We used multivariate logistic regression analysis to assess odds ratios (ORs) for association between arsenic exposure and PKDL development.
  
  
  RESULTS
  Out of the 429 water samples tested, 403 had arsenic content of over 10 μg/L, with highest level of 432 μg/L among the seven study villages. Multivariate adjusted ORs for risk of PKDL development in comparison of arsenic concentrations of 10.1-200 μg/L and 200.1-432.0 μg/L were 1.85 (1.13-3.03) and 2.31 (1.39-3.8) respectively. Interestingly, similar results were found for daily dose of arsenic and total arsenic concentration in urine sample of the individual. The multivariate-adjusted OR for comparison of high baseline arsenic exposure to low baseline arsenic exposure of the individuals in the study cohort was 1.66 (95% CI 1.02-2.7; p = 0.04).
  
  
  CONCLUSIONS
  Our findings indicate the need to consider environmental factors, like long time arsenic exposure, as an additional influence on treated VL patients towards risk of PKDL development in Bihar.
authors: Department of Microbiology, All-India Institute of Medical Sciences, Patna, Bihar, India.
authors: Sushmita
authors: S
authors: Das
authors: Department of Vector Biology, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research (I.C.M.R.), Patna, Bihar, India.
authors: Rakesh
authors: R
authors: Mandal
authors: Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research (I.C.M.R.), Patna, Bihar, India.
authors: Vidya Nand
authors: VN
authors: Rabidas
authors: Department of Pathology, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research (I.C.M.R.), Patna, Bihar, India.
authors: Neena
authors: N
authors: Verma
authors: Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research (I.C.M.R.), Patna, Bihar, India.
authors: Krishna
authors: K
authors: Pandey
authors: Department of Environment and Water Management, A.N. College, Patna, Bihar, India.
authors: Ashok Kumar
authors: AK
authors: Ghosh
authors: Department of Vector Biology, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research (I.C.M.R.), Patna, Bihar, India.
authors: Sreekant
authors: S
authors: Kesari
authors: Department of Pathology, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research (I.C.M.R.), Patna, Bihar, India.
authors: Ashish
authors: A
authors: Kumar
authors: Department of Pathology, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research (I.C.M.R.), Patna, Bihar, India.
authors: Bidyut
authors: B
authors: Purkait
authors: Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research (I.C.M.R.), Patna, Bihar, India.
authors: Chandra Sekhar
authors: CS
authors: Lal
authors: Department of Pathology, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research (I.C.M.R.), Patna, Bihar, India.
authors: Pradeep
authors: P
authors: Das
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001151:Arsenic / Q000633:toxicity* / Q000652:urine; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D060766:Drinking Water / Q000737:chemistry; D004781:Environmental Exposure; D004785:Environmental Pollutants / Q000032:analysis / Q000633:toxicity; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000469:parasitology; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D060766:Drinking Water; D004785:Environmental Pollutants; D001151:Arsenic; D000967:Antimony Sodium Gluconate