{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T23:58:35Z","timestamp":1789171115134,"version":"build-2803163510"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background &amp; objectives:<\/jats:title>\n                    <jats:p>\n                      Visceral leishmaniasis (VL, or Kala-azar) is a potentially lethal vector-borne disease caused by intracellular protozoa of the genus\n                      <jats:italic toggle=\"yes\">Leishmania<\/jats:italic>\n                      , serves as the primary reservoir; traditionally endemic to Bihar, Jharkhand, West Bengal, and Eastern Uttar Pradesh Indian states along river belts. VL has recently been observed in the past few years at a tertiary care teaching hospital located in the Himalayan region (non-endemic state, Uttarakhand). This study was done to identify the clinical features, demographics, complications and the risk factors involved in patients of non-endemic region a tertiary care hospital.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective study with present-day follow-up of all patients was done on VL patients who were admitted from January 2018 to January 2024. Diagnosis was established by rK 39 antigen test and\/or Leishman-Donovan (LD) bodies on bone marrow examination. The clinical and laboratory data, duration of hospital stay and outcomes, and associated risk factors were collected on a proforma and analysed. Factors associated with Himalayan region (Uttarakhand) above Rishikesh (&gt;1120 feet from sea level) were analysed using Chi-square.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Males constituted 92% of the study population from which 67% of the population was from the Himalayan region of this middle Southern Himalaya (Uttarakhand). Risk factors such as residence in the rural area (p=0.47), residence near vegetation (p=0.12), poor household characteristics (p=0.073), low educational status (p=0.073), nearby water body (p=0.073), poor sewage or garbage disposal (p=0.241), insect bites (p=0.040) were associated with Himalayan region emergence. Fever (100%) and malaise (100%) were the most common symptoms presented followed by pain abdomen (29%). Pallor (100%) and splenomegaly (100%) were the most common abnormalities identified on examination followed by hepatomegaly (83%). Anemia (100%) and leukopenia (100%) were the most common biochemical abnormality detected followed by thrombocytopenia (79%), acute liver injury (63%), and hemophagocytic lymphohistiocytosis (HLH) (58%). The disease was diagnosed by the rK39 antigen test (67%), LD bodies in bone marrow examination (67%) and both positive in 29% patients. Mortality was seen in 17 % patients secondary to sepsis (75%) and one case post-discharge due to unknown reasons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation &amp; conclusion:<\/jats:title>\n                    <jats:p>VL is emerging in Himalayan (Uttarakhand) region and has been found to have higher mortality and organ involvement (hepatomegaly) compared to non-Himalayan region. This calls for initiating a surveillance program before declaring elimination\/eradication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jvbd.jvbd_231_24","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T04:02:31Z","timestamp":1747627351000},"page":"503-508","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Emerging visceral leishmaniasis patients in mid Southern Himalayan region: A public health concern"],"prefix":"10.4103","volume":"62","author":[{"given":"Shivnarayan","family":"Sahu","sequence":"first","affiliation":[{"name":"Department of Medicine (ID Division), All India Institute of Medical Sciences (AIIMS), Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasan Kumar","family":"Panda","sequence":"additional","affiliation":[{"name":"Department of Medicine (ID Division), All India Institute of Medical Sciences (AIIMS), Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YP","family":"Mathuria","sequence":"additional","affiliation":[{"name":"Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogesh Arvind","family":"Bahurupi","sequence":"additional","affiliation":[{"name":"Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, India"},{"name":"Department of Community Medicine, All India Institute of Medical Sciences (AIIMS), Nagpur, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"issue":"11","key":"R1-20251215","first-page":"2292","article-title":"Visceral Leishmaniasis: Epidemiology, Diagnosis, and Treatment Regimens in Different Geographical Areas with a Focus on Pediatrics","volume":"10","author":"Scarpini","year":"2022","journal-title":"Microorganisms"},{"issue":"2","key":"R2-20251215","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5495\/wjcid.v13.i2.11","article-title":"Emerging leishmaniasis in southern Himalayas: A mini-review","volume":"13","author":"Sharma","year":"2023","journal-title":"World J Clin Infect Dis"},{"issue":"1","key":"R3-20251215","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1182\/asheducation-2009.1.127","article-title":"Hemophagocytic lymphohistiocytosis (HLH) and related disorders","volume":"2009","author":"Filipovich","year":"2009","journal-title":"Hematology Am Soc Hematol Educ Program"},{"issue":"3","key":"R4-20251215","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.4103\/jfmpc.jfmpc_1174_19","article-title":"Rising visceral leishmaniasis in Holy Himalayas (Uttarakhand, India) - A cross-sectional hospital-based study","volume":"9","author":"Kumari","year":"2020","journal-title":"J Family Med Prim Care"},{"key":"R5-20251215","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s00436-019-06575-5","article-title":"Environmental and socioeconomic risk factors associated with visceral and cutaneous leishmaniasis: a systematic review","volume":"119","author":"Valero","year":"2020","journal-title":"Parasitology Research"},{"issue":"10","key":"R6-20251215","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.cgh.2008.04.033","article-title":"High prevalence of functional liver derangement in Visceral Leishmaniasis at an Indian Tertiary Care Center","volume":"6","author":"Mathur","year":"2008","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"R7-20251215","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.trstmh.2010.09.006","article-title":"Diagnosis of visceral leishmaniasis","volume":"105","author":"Srivastava","year":"2011","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"3","key":"R8-20251215","doi-asserted-by":"crossref","first-page":"e0011938","DOI":"10.1371\/journal.pntd.0011938","article-title":"Diagnostic accuracy of serological rk-39 test for visceral Leishmaniasis: Systematic review and meta-analysis","volume":"18","author":"Getnet","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"key":"R9-20251215","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1056\/NEJMoa0903627","article-title":"Single-Dose Liposomal Amphotericin B for Visceral Leishmaniasis in India","volume":"362","author":"Sundar","year":"2010","journal-title":"N Engl J Med"},{"key":"R10-20251215","doi-asserted-by":"crossref","first-page":"881","DOI":"10.2147\/IDR.S245991","article-title":"Incidence of mortality and its predictors among adult visceral leishmaniasis patients at the university of gondar hospital: A retrospective cohort study","volume":"13","author":"Yeshaw","year":"2020","journal-title":"Infect Drug Resist"},{"key":"R11-20251215","first-page":"100041","article-title":"Estimating the proportion of relapse following treatment of Visceral Leishmaniasis: meta-analysis using Infectious Diseases Data Observatory (IDDO) systematic review","volume":"9","author":"Chhajed","year":"2024","journal-title":"Lancet Reg Health Southeast Asia"},{"issue":"2","key":"R12-20251215","first-page":"104","article-title":"Changing epidemiology: A new focus of kala-azar at high-altitude garhwal region of North India","volume":"63","author":"Bhat","year":"2017","journal-title":"J Trop Pediatr"}],"container-title":["Journal of Vector Borne Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jvbd.jvbd_231_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:50:37Z","timestamp":1787773837000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jvbd.jvbd_231_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":12,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/jvbd.jvbd_231_24","relation":{},"ISSN":["0972-9062"],"issn-type":[{"value":"0972-9062","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2024-12-18","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-08","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}