10 research outputs found
Chronic Arsenic Exposure and Risk of Post Kala-azar Dermal Leishmaniasis Development in India: A Retrospective Cohort Study.
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). CONCLUSION: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
Village-wise PKDL case distribution.
<p>Village-wise PKDL case distribution in the study cohort of Raghopur block, Vaishali district, Bihar, India.</p
Comparative status for history of VL episode of the PKDL cases in the study cohort.
<p>Comparative status for history of VL episode of the PKDL cases in the study cohort.</p
Distribution of arsenic contamination in groundwater and PKDL cases in the study cohort.
<p>A: Map of Raghopur block showing spatial distribution of inhabitants, B. Distribution of arsenic in groundwater in seven villages of the study cohort, C. Overlap of location of PKDL cases with distribution of arsenic in groundwater in seven villages of the study cohort.</p
Map of the study cohort.
<p>A. Map of Bihar state, India with the boxed study cohort. B. Detailed map of Raghopur block showing the study cohort with seven villages of interest; details of water bodies, land and inhabitant distribution.</p
Distribution of PKDL cases in respect to variable arsenic concentrations in the study cohort.
<p>Distribution of PKDL cases in respect to variable arsenic concentrations in the study cohort.</p
Chronic Arsenic Exposure and Risk of Post Kala-azar Dermal Leishmaniasis Development in India: A Retrospective Cohort Study
<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>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).</p><p>Conclusion</p><p>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.</p></div
Flow chart of the study population.
<p>Flow chart of the study population from PKDL patients who were treated at Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar between 2009 and 2014.</p
Odds ratios (ORs) for risk of PKDL development in the study participants in association to arsenic exposure.
<p>Odds ratios (ORs) for risk of PKDL development in the study participants in association to arsenic exposure.</p