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We examined the epidemiology of kala-azar and asymptomatic leishmanial infection measured by serologic and leishmanin skin test results in a Bangladeshi community. In a subset, we measured serum retinol, zinc and C-reactive protein (CRP). Kala-azar and seroconversion incidence were 15.6 and 63.1 per 1,000 person-years, respectively. Proximity to a previous kala-azar case increased the likelihood of both kala-azar and asymptomatic infection. Bed net use protected against kala-azar (rate ratio = 0.35, P < 0.01), but not subclinical infection (rate ratio = 1.1, P = 0.82). Kala-azar patients were younger (P < 0.001) and reported lower red meat consumption (P < 0.01) than asymptomatic seropositive individuals. Retinol and zinc levels were lower in current kala-azar patients and those who later developed kala-azar compared with uninfected and asymptomatically infected subjects. The CRP levels were higher in kala-azar patients compared with the other two groups. Low red meat intake and poor zinc and retinol status may characterize a group at higher risk of symptomatic disease.
Received November 24, 2006. Accepted for publication February 1, 2007.
Acknowledgments: We thank our fieldworkers for their dedication and residents of the study community for their willing participation; and the following persons for field support and scientific advice: Steve Luby, Dilara Sultana, Milton Quiah, Hasnat Iftekhar Hossain, Pradip Rozario, Mustak Ahmed, Emily Gurley, David Sack, M. G. Datta, A. Hamid, S. M. Alam, I. Khalil, Allen Hightower, Selma Jeronimo, Alan Magill, Marleen Boelaert, Bruno Bucheton, and Jorge Alvar. We also thank Corixa Corporation for providing rK39 antigen and Syamal Raychaudhuri (Inbios International, Inc.) for donation rK39 rapid tests.
Financial support: This study was supported by a grant from the CDC Emerging Infections Initiative and by core donors to the International Centre for Diarrhoeal Disease Research, Bangladesh.
* Address correspondence to Caryn Bern, Division of Parasitic Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta GA 30341. E-mail: CBern{at}cdc.gov
Authors’ addresses: Caryn Bern, John Williamson, and W. Evan Secor, Division of Parasitic Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta GA 30341, Telephone: 770-488-7654, Fax: 770-488-7761, E-mail: CBern{at}cdc.gov. Rashidul Haque, Rajib Chowdhury, Mustakim Ali, and M. A. Wahed, Centre for Health and Population Research, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh. Katie Kurkjian, School of Public Health, University of North Carolina, Chapel Hill, NC 27599. Louise Vaz, Vanderbilt University School of Medicine, 21st Avenue South, Nashville, TN 37232. Josef Amann, Office of Global Health, Centers for Disease Control and Prevention, Atlanta GA 30341. Yukiko Wagatsuma, Department of Epidemiology, 1-1-1 Tennodai, University of Tsukuba, Ibaraki 305-8575, Japan. Robert Breiman, Centers for Disease Control and Prevention–Kenya International Emerging Infections Program, Nairobi, Kenya. James H. Maguire, Division of International Health, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201.
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