{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T23:01:21Z","timestamp":1781737281170,"version":"3.54.5"},"reference-count":37,"publisher":"FapUNIFESP (SciELO)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Soc. Bras. Med. Trop."],"published-print":{"date-parts":[[2010,8]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1590\/s0037-86822010000400010","type":"journal-article","created":{"date-parts":[[2011,2,24]],"date-time":"2011-02-24T19:35:40Z","timestamp":1298576140000},"page":"386-392","source":"Crossref","is-referenced-by-count":90,"title":["Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study"],"prefix":"10.1590","volume":"43","author":[{"given":"Carlos Henrique Nery","family":"Costa","sequence":"first","affiliation":[{"name":"Tropical Diseases Institute Natan Portella, Brazil; Federal University of Piau\u00ed, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Loureiro","family":"Werneck","sequence":"additional","affiliation":[{"name":"Oswaldo Cruz Foundation, Brazil; Federal University of Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorcas Lamounier","family":"Costa","sequence":"additional","affiliation":[{"name":"Federal University of Minas Gerais, Brazil; Federal University of Piau\u00ed, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago Ayres","family":"Holanda","sequence":"additional","affiliation":[{"name":"Federal University of Piau\u00ed, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme 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