Risk Factors for Death in Children with Visceral Leishmaniasis

Visceral leishmaniasis (VL) is a deadly disease caused by a protozoan called Leishmania. It is transmitted to humans from infected animals by a sandfly bite. Most people actually manage to control the infection and do not get sick, while others develop a range of symptoms. VL impairs the production of blood components and causes the immune system to malfunction, thus anemia, bleeding, and bacterial infections often complicate the disease and can lead to death. To identify risk factors for death from VL, the authors studied 546 children in a referral center in Recife, Brazil. They looked at clinical history, physical examination and full blood counts on the assumption these could be easily assessed in peripheral health facilities. They found that the presence of fast breathing, jaundice, mucosal (e.g. gum) bleeding and bacterial infections would each increase the risk of death in three to four-fold. The presence of very low counts of neutrophils and platelets would increase the risk of death in three and 12-fold respectively. This knowledge can help clinicians to anticipate the use of antibiotics or transfusion of blood products in high risk patients, who would potentially benefit from transfer to centers with advanced life support facilities

Predictive Models for the Diagnostic of Human Visceral Leishmaniasis in Brazil

Visceral leishmaniasis (VL) is a neglected tropical disease endemic to 65 countries, including Brazil, where the disease frequently occurs in remote locations and treatment is often performed on the basis of clinical suspicion. Predictive models based on scoring systems could be a helpful tool for the clinical management of VL. Based on clinical signs and symptoms, and five different serological tests of 213 patients with parasitologically confirmed (cases) and 119 with clinical suspicion of VL but with another confirmed etiology (non-cases), twelve prediction models using logistic regression and classification and regression trees (CART) for VL diagnosis were developed. The model composed of the clinical-laboratory variables and the rk39 rapid test showed the best performance in both logistic regression and CART (Sensitivity of 90.1% and specificity ranging from 97.2–97.4%). The scoring system is simple and based on the clinical-laboratory findings that are easily available in most clinical settings. The results suggest that those models might be useful in locations where access to available diagnostic methods is difficult, contributing to more efficient and more rational allocation of healthcare resources