{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:01:36Z","timestamp":1792796496512,"version":"4.5.0"},"reference-count":64,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T00:00:00Z","timestamp":1493683200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>An infected host's <jats:italic>Leishmania infantum<\/jats:italic> load in blood is considered to be an estimate of his or her total parasite burden. Therefore, the measurement of blood parasite burden is important in the identification of factors involved in parasite control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Quantitative polymerase chain reaction was performed on blood samples from 625 patients with kala\u2010azar consecutively admitted to a reference hospital in Teresina, Brazil. Primers were used to amplify a segment of <jats:styled-content style=\"fixed-case\">kDNA<\/jats:styled-content> using the TaqMan system. Non\u2010parametric statistical tests were applied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median blood parasite burden was 499.2 amastigote equivalents (<jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>)\/ml. Children &lt;1 year old (yo) had a high parasite burden, which dropped sharply after the first year of life (192.8, <jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>\/ml at 1 &lt; 2 yo) and remained lower until adolescence. Following adolescence, the parasite burden increased with age, peaking among elderly individuals. Men had a higher parasite burden than women. <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010infected patients had a much higher parasite burden than non\u2010infected patients. The parasite burden of children under 5 years with acute moderate to severe malnourishment (weight\u2010for\u2010age and body mass index <jats:italic>z<\/jats:italic>\u2010scores &lt;\u22122) was almost three times greater than that of better\u2010nourished children. The parasite burden identified in deceased patients was more than twice that of surviving patients; those with a higher risk of death, sepsis, pneumonia and jaundice also had increased parasite burdens. All of these differences were statistically significant at <jats:italic>P<\/jats:italic>\u2010values &lt;0.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These data indicate that the parasite burden in patients with kala\u2010azar was associated with age\u2010 and gender\u2010associated factors and with <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> infection status. Acute malnutrition could be either a cause or a consequence of a higher parasite burden. An individual's parasite burden influences his or her clinical profile, disease severity and mortality risk. The best explanation for the presence of a higher parasite burden in individuals with these immunoregulatory conditions and severe disease is the occurrence of acquired immunosuppression followed by heightened innate immunity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12877","type":"journal-article","created":{"date-parts":[[2017,4,5]],"date-time":"2017-04-05T22:25:31Z","timestamp":1491431131000},"page":"679-687","source":"Crossref","is-referenced-by-count":32,"title":["Causes and consequences of higher <i>Leishmania infantum<\/i> burden in patients with kala\u2010azar: a study of 625 patients"],"prefix":"10.1111","volume":"22","author":[{"given":"Danielle A.","family":"Zacarias","sequence":"first","affiliation":[{"name":"Laborat\u00f3rio de Leishmanioses Instituto de Doen\u00e7as Tropicais Natan Portella Universidade Federal do Piau\u00ed Teresina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuno","family":"Rol\u00e3o","sequence":"additional","affiliation":[{"name":"Instituto de Higiene e Medicina Tropical Universidade Nova de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flaviane A.","family":"de Pinho","sequence":"additional","affiliation":[{"name":"Setor de Patologia Animal Centro de Ci\u00eancias Agr\u00e1rias Universidade Federal do Piau\u00ed Teresina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingridi","family":"Sene","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Leishmanioses Instituto de Doen\u00e7as Tropicais Natan Portella Universidade Federal do Piau\u00ed Teresina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jailthon C.","family":"Silva","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Leishmanioses Instituto de Doen\u00e7as Tropicais Natan Portella Universidade Federal do Piau\u00ed Teresina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresinha C.","family":"Pereira","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Leishmanioses Instituto de Doen\u00e7as Tropicais Natan Portella Universidade Federal do Piau\u00ed Teresina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorcas L.","family":"Costa","sequence":"additional","affiliation":[{"name":"Departamento Materno\u2010Infantil Universidade Federal do Piau\u00ed Teresina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos H. 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