Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study A leishmaniose visceral grave é uma síndrome da resposta inflamatória sistêmica? Um estudo caso-controle

• Published in: Revista da Sociedade Brasileira de Medicina Tropical
• Main Authors: Carlos Henrique Nery Costa, Guilherme Loureiro Werneck, Dorcas Lamounier Costa, Thiago Ayres Holanda, Guilherme Brasileiro Aguiar, Aline Santos Carvalho, Janaína Costa Cavalcanti, Loryenne Santos Santos
• Format: Article in Journal/Newspaper
• Language: English
• Published: Sociedade Brasileira de Medicina Tropical (SBMT) 2010
• Subjects: Leishmaniose visceral; Calazar; Síndrome da resposta inflamatória sistêmica; AIDS; Sangramento; Visceral leishmaniasis; Kala-azar; Severe inflammatory response syndrome; Bleeding; Arctic medicine. Tropical medicine; RC955-962; Arctic; Azar
• Online Access: https://doi.org/10.1590/S0037-86822010000400010; https://doaj.org/article/695b06cc52a74f81be41677f21dc0d1c

INTRODUCTION: The objective of the study is to identify the main risk factors for death by New World visceral leishmaniasis and establish a coherent pathogenic substrate of severe disease based on clinical findings. METHODS: Seventy-six deceased inpatients and 320 successfully treated inpatients with VL were studied in a case control study. RESULTS: Bacterial infection and bleeding were mutually exclusive events leading to death. Five risk factors were unique for death by bacterial infection (malnutrition, pulmonary rales, severe anemia, severe absolute neutropenia and higher neutrophil count), while another six were unique for death by bleeding (jaundice, severe relative neutropenia, severe thrombocytopenia, liver injury, kidney failure, higher bone marrow parasite load). Bacterial infection, bleeding, severe anemia, diarrhea, dyspnea, edema, jaundice and bone marrow parasite load were the main syndromes of visceral leishmaniasis among successfully treated patients. CONCLUSIONS: The data support the idea that bacterial infections are due to immune paralysis. Broad organ and system involvement is plausibly due to the high production of proinflammatory cytokines, whose actions fit well with visceral leishmaniasis. The syndromes and causative mediators are typical of a slowly developing systemic inflammatory response syndrome. INTRODUÇÃO: O objetivo do estudo foi i dentificar os principais fatores de risco para morte na leishmaniose visceral do Novo Mundo e estabelecer um substrato patogênico baseado nos achados clínicos coerente para doença grave. MÉTODOS: Em um estudo caso-controle, foram estudados 76 pacientes internados que faleceram e 320 pacientes internados tratados com sucesso. RESULTADOS: Infecção bacteriana e sangramento foram eventos que levaram à morte, mutuamente exclusivos. Cinco fatores de risco foram únicos para morte por infecção bacteriana (desnutrição, estertores pulmonares, anemia grave, neutropenia absoluta grave e número de leucócitos aumentados), enquanto outros seis foram exclusivos para ...