Evaluation of medullary cytokine expression and clinical and laboratory aspects in severe human visceral leishmaniasis.

BACKGROUND: Visceral leishmaniasis (VL) is a serious public health problem. The factors that can determine whether VL develops and progresses to severe form have not been fully identified, but a specific cellular immune response appears to play a key role. Therefore, understanding immunopathogenesis can be useful in preventing a serious clinical outcome. MATERIALS AND METHODS: Bone marrow samples were collected from patients with severe VL (SVL) or non-severe VL (NSVL). Cytokine levels and parasitic load were analysed by RT-qPCR. There is a statistically significant difference in the leukocyte parameter in patients with SVL and NSVL compared with the control patients (p = .006 and p = .014, respectively). RESULTS: Urea, alanine transaminase and albumin parameters had a significant difference p = .036, p = .039 and p = .017, respectively, between SVL and NSVL. Although high levels of IFN-γ, IL-10, IL-6 and TNF-α were present in all groups of individuals with VL, they were not statistically associated with severity. In patients with active VL, IFN-γ and IL-10 were associated, respectively, with a reduction and increase in the parasite load, strong and significant positive association between IFN-γ and IL-10 (rho = .627 and p = .003). CONCLUSION: This study demonstrates that VL stimulates an non-dichotomized inflammatory response between Th1/Th2 and that bone marrow is an important tissue for immune regulation.

Hemophagocytic lymphohistiocytosis secondary to visceral leishmaniasis in an endemic area in the north of Minas Gerais, Brazil.

INTRODUCTION: Visceral leishmaniasis (VL) is an ill-studied disease that is endemic to several regions of Brazil. It is often complicated by hemophagocytic lymphohistiocytosis (HLH), a potentially fatal disorder resulting from excessive non-malignant activation/proliferation of T lymphocytes and macrophages. Considering the overlapping clinical and laboratory characteristics of these diseases, diagnosing HLH is a challenge. Therefore, tracking the association between VL and HLH is necessary in endemic areas. Although HLH can be inapparent and resolve with antileishmanicides, this may not always occur. HLH causes high lethality; therefore, immunosuppressive therapy should be instituted immediately in order to avoid a fatal outcome. METHODS: We described the epidemiological, clinical, laboratory, and therapeutic profile of this association in a region of Brazil endemic for VL. RESULTS: We presented 39 patients with this association in a retrospective cohort of 258 children who were admitted from January 2012 to June 2017. Of the 39 patients, 31 were from urban areas (79.5%), and 21 (53%) were males. The mean age and weight were 2.86 (2.08) years and 14.03 (5.96) kg, respectively. The main symptoms were fever (100%), hepatosplenomegaly (100%), pallor of the skin and mucosa (82.5%), edema (38.5%), bleeding (25%), and jaundice (7.5%). Hemophagocytosis was identified in 16/37 (43.24%) patients, and direct examination revealed that 26/37 (70.27%) patients were positive for VL. The patients were treated as recommended by the Ministry of Health. CONCLUSIONS: It was observed that HLH is a common complication in endemic areas, and its diagnosis must consider the overlapping of clinical characteristics and pancytopenia.

Hemophagocytic lymphohistiocytosis secondary to visceral leishmaniasis in an endemic area in the north of Minas Gerais, Brazil

Abstract INTRODUCTION Visceral leishmaniasis (VL) is an ill-studied disease that is endemic to several regions of Brazil. It is often complicated by hemophagocytic lymphohistiocytosis (HLH), a potentially fatal disorder resulting from excessive non-malignant activation/proliferation of T lymphocytes and macrophages. Considering the overlapping clinical and laboratory characteristics of these diseases, diagnosing HLH is a challenge. Therefore, tracking the association between VL and HLH is necessary in endemic areas. Although HLH can be inapparent and resolve with antileishmanicides, this may not always occur. HLH causes high lethality; therefore, immunosuppressive therapy should be instituted immediately in order to avoid a fatal outcome. METHODS: We described the epidemiological, clinical, laboratory, and therapeutic profile of this association in a region of Brazil endemic for VL. RESULTS We presented 39 patients with this association in a retrospective cohort of 258 children who were admitted from January 2012 to June 2017. Of the 39 patients, 31 were from urban areas (79.5%), and 21 (53%) were males. The mean age and weight were 2.86 (2.08) years and 14.03 (5.96) kg, respectively. The main symptoms were fever (100%), hepatosplenomegaly (100%), pallor of the skin and mucosa (82.5%), edema (38.5%), bleeding (25%), and jaundice (7.5%). Hemophagocytosis was identified in 16/37 (43.24%) patients, and direct examination revealed that 26/37 (70.27%) patients were positive for VL. The patients were treated as recommended by the Ministry of Health. CONCLUSIONS It was observed that HLH is a common complication in endemic areas, and its diagnosis must consider the overlapping of clinical characteristics and pancytopenia.

Perfil epidemilógico dos acidentes causados por serpentes venenosas no norte do estado de Minas Gerais, Brasil / Epidemiological profile of accidents caused by venomous snakes in the northern part of the state of Minas Gerais, Brasil

Introdução: os acidentes causados por serpentes venenosas são importante problema de saúde pública devido à sua elevada morbimortalidade. Objetivo: descrever o perfil epidemiológico dos acidentes ofídicos causados por serpentes venenosas no nortedo estado de Minas Gerais. Métodos: foram analisadas informações sobre acidentes ofídicos relativas ao período compreendido entre janeiro de 2002 e dezembro de 2006, por meio de dados obtidos dos bancos SINAN WINDOWS e SINAN NET. Resultados: foram notificados 816 casos; 695 (85%) devidos às serpentes do gênero Bothrops; 334(41%) no primeiro trimestre; 593 (73%) na região de Montes Claros; 701 (86%) na zona rural; 328 (40%) picadas nos pés; 695 (85%) receberam soroterapia; 297 (36%) demoraram uma a três horas, em média, após o acidente, para receberam tratamento; e em 681 (83%) a cicatrização da ferida não apresentou sequelas. Conclusões: os dadosclínico-epidemiológicos permitem reconhecer vários aspectos que possibilitam atitudes médicas de prevenção e abordagem terapêutica adequada ao acidente ofídico no norte de Minas Gerais.

Introduction: the casualties related to venomous snakes are important public health issue due to its high morbidity and mortality. Objective: to describe the epidemiological profile of the casualties due to venomous snakes in the northern part of the State of Minas Gerais. Methods: information about snakebites casualties in the period between January 2002 and December 2006 were analyzed, through database from SINAN WINDOWS and SINAN NET. Results: 816 cases were reported; 695 (85%) due to snakes of the kind Bothrops; 334 (41%) in the first quarter of the year; 593 (73%) in the region of Montes Claros; 701 (86%) in the countryside; 328 (40%) bites on the feet; 695 (85%) received sorotherapy; 297 (36%) took one to three hours on average to receive treatment, and in 681 (83%) wound healing showed no sequels. Conclusions: clinic-epidemiological data allow the recognition of various aspects that enable preventive medical attitudes and appropriate therapeutic approach to snakebite in northern Minas Gerais.

[Profile of snakebite accidents in the north of the State of Minas Gerais, Brazil]. / Perfil dos acidentes ofídicos no norte do Estado de Minas Gerais, Brasil.

The aim of this study was to describe the epidemiological profile of snakebite accidents in the healthcare macroregion of the north of the State of Minas Gerais, Brazil. Database information on snakebite accidents covering the period from January 2002 to December 2006 was analyzed. It was found that 10,553 cases were notified, and that the samples were noticeably larger in the months of hot and rainy weather, in urban areas (54.1%), at ages less then 20 years (39.7%) and among men and students (53.1% and 29.1%) respectively. The lower limbs (feet, toes, legs and thighs) were the locations most affected (35.9%). The most prevalent snakes were in the genus Bothrops (82.9%) and most of the accidents were mild (66.2%). In this study, it was seen that the seasonality, urbanization and undernotification of the species involved in these accidents had a notable impact, along with seeking walk-in care. It is expected that the new data obtained from this sample may serve as the substrate for planning and implementing measures for healthcare surveillance.

Perfil dos acidentes ofídicos no norte do Estado de Minas Gerais, Brasil / Profile of snakebite accidents in the north of the State of Minas Gerais, Brazil

O objetivo deste estudo foi descrever o perfil epidemiológico dos acidentes ofídicos da macrorregião de saúde do Norte do Estado de Minas Gerais, Brasil. Foram analisadas informações sobre os acidentes ofídicos relativos ao período compreendido entre janeiro de 2002 a dezembro de 2006, por meio de bancos de dados. Os resultados demonstraram 10.553 casos notificados, com ênfase para a maior casuística em meses de tempo quente e chuvoso, em áreas urbanas (54,1 por cento), faixa etária menor de 20 anos (39,7 por cento), acometendo mais homens e estudantes (53,1 por cento e 29,1 por cento) respectivamente. Os membros inferiores (pé, dedo do pé, perna e coxa) foram os locais mais afetados (35,9 por cento), as serpentes prevalentes foram do gênero Bothrops (82,9 por cento) e a gravidade da maioria dos acidentes foi leve (66,2 por cento). Observou-se nesse estudo um importante impacto da sazonalidade, urbanização, subnotificação das espécies envolvidas nesses acidentes e busca rápida pelo pronto atendimento. Espera-se que os dados inéditos da casuística obtida possam servir de substrato para o planejamento e execução de medidas voltadas para vigilância em saúde e atendimento.

The aim of this study was to describe the epidemiological profile of snakebite accidents in the healthcare macroregion of the north of the State of Minas Gerais, Brazil. Database information on snakebite accidents covering the period from January 2002 to December 2006 was analyzed. It was found that 10,553 cases were notified, and that the samples were noticeably larger in the months of hot and rainy weather, in urban areas (54.1 percent), at ages less then 20 years (39.7 percent) and among men and students (53.1 percent and 29.1 percent) respectively. The lower limbs (feet, toes, legs and thighs) were the locations most affected (35.9 percent). The most prevalent snakes were in the genus Bothrops (82.9 percent) and most of the accidents were mild (66.2 percent). In this study, it was seen that the seasonality, urbanization and undernotification of the species involved in these accidents had a notable impact, along with seeking walk-in care. It is expected that the new data obtained from this sample may serve as the substrate for planning and implementing measures for healthcare surveillance.