Abstract:
BACKGROUND:In the late twentieth century, emergence of high rates of treatment failure with antimonial compounds (SSG) for visceral leishmaniasis (VL) caused a public health crisis in Bihar, India. We hypothesize that exposure to arsenic through drinking contaminated groundwater may be associated with SSG treatment failure due to the development of antimony-resistant parasites. METHODS:A retrospective cohort design was employed, as antimony treatment is no longer in routine use. The study was performed on patients treated with SSG between 2006 and 2010. Outcomes of treatment were assessed through a field questionnaire and treatment failure used as a proxy for parasite resistance. Arsenic exposure was quantified through analysis of 5 water samples from within and surrounding the patient's home. A logistic regression model was used to evaluate the association between arsenic exposure and treatment failure. In a secondary analysis survival curves and Cox regression models were applied to assess the risk of mortality in VL patients exposed to arsenic. RESULTS:One hundred and ten VL patients treated with SSG were analysed. The failure rate with SSG was 59%. Patients with high mean local arsenic level had a non-statistically significant higher risk of treatment failure (OR = 1.78, 95% CI: 0.7-4.6, p = 0.23) than patients using wells with arsenic concentration <10 μg/L. Twenty one patients died in our cohort, 16 directly as a result of VL. Arsenic levels ≥ 10 μg/L increased the risk of all-cause (HR 3.27; 95% CI: 1.4-8.1) and VL related (HR 2.65; 95% CI: 0.96-7.65) deaths. This was time dependent: 3 months post VL symptom development, elevated risks of all-cause mortality (HR 8.56; 95% CI: 2.5-29.1) and of VL related mortality (HR 9.27; 95% CI: 1.8-49.0) were detected. DISCUSSION/CONCLUSION:This study indicates a trend towards increased treatment failure in arsenic exposed patients. The limitations of the retrospective study design may have masked a strong association between arsenic exposure and selection for antimonial resistance in the field. The unanticipated strong correlation between arsenic exposure and VL mortality warrants further investigation.
journal_name
PLoS Negl Trop Disjournal_title
PLoS neglected tropical diseasesauthors
Perry MR,Prajapati VK,Menten J,Raab A,Feldmann J,Chakraborti D,Sundar S,Fairlamb AH,Boelaert M,Picado Adoi
10.1371/journal.pntd.0003518subject
Has Abstractpub_date
2015-03-02 00:00:00pages
e0003518issue
3eissn
1935-2727issn
1935-2735pii
PNTD-D-14-01058journal_volume
9pub_type
杂志文章abstract:BACKGROUND:Health promotion is essential to the SAFE strategy for trachoma elimination. Schools are a valuable venue for health promotion. However, there is little literature about the impact of health education and water infrastructure in schools on facial cleanliness and trachoma in the community. Our study aimed to ...
journal_title:PLoS neglected tropical diseases
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journal_title:PLoS neglected tropical diseases
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pub_type: 杂志文章
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2014-01-16 00:00:00
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journal_title:PLoS neglected tropical diseases
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章
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journal_title:PLoS neglected tropical diseases
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章
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journal_title:PLoS neglected tropical diseases
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pub_type: 杂志文章
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章,随机对照试验
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更新日期:2017-11-08 00:00:00
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章,随机对照试验
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章
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更新日期:2016-11-21 00:00:00
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章
doi:10.1371/journal.pntd.0002285
更新日期:2013-06-20 00:00:00
abstract::The World Health Organization, the World Organization for Animal Health, and the Food and Agriculture Organization have resolved to eliminate human rabies deaths due to dog bites by 2030, and the Vaccine Alliance (Gavi) has added human rabies vaccines to their investments for 2021-2025. Implementing these goals cost-e...
journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章
doi:10.1371/journal.pntd.0007630
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章,评审
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更新日期:2015-06-25 00:00:00
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章
doi:10.1371/journal.pntd.0001882
更新日期:2012-01-01 00:00:00
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章
doi:10.1371/journal.pntd.0001645
更新日期:2012-01-01 00:00:00