A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan

Abstract

BackgroundSouth Sudan is one of the most endemic countries for visceral leishmaniasis (VL), and is frequently affected by large epidemics. In resource-limited settings, clinicians require a simple clinical tool to identify VL patients who are at increased risk of dying, and who need specialised treatment with liposomal amphotericin B and other supportive care. The aim of this study was to develop and validate a clinical severity scoring system based on risk factors for death in VL patients in South Sudan.MethodsA retrospective analysis was conducted of data from a cohort of 6,633 VL patients who were treated in the Médecins Sans Frontières (MSF) hospital in Lankien between July 2013 and June 2015. Risk factors for death during treatment were identified using multivariable logistic regression models, and the regression coefficients were used to develop a severity scoring system. Sensitivity and specificity of score cut-offs were assessed by receiver operating characteristic (ROC) analysis.ResultsIn multivariable models, risk factors for death in adult VL patients were: anaemia (odds ratio (OR) 4.46 (95% CI 1.58–12.6) for Hb <6g/dL compared with ≥9g/dL), nutritional status (OR 4.84 (2.09–11.2) for BMI <13 kg/m2 compared with ≥16 kg/m2), weakness (OR 4.20 (1.82–9.73) for collapsed compared with normal weakness), jaundice (OR 3.41 (1.17–9.95)), and oedema/ascites (OR 4.86 (1.67–14.1)). For children and adolescents the risk factors were: age (OR 10.7 (6.3–18.3) for age <2 years compared with 6–18 years), anaemia (OR 7.76 (4.15–14.5) for Hb <6g/dL compared with ≥9g/dL), weakness (OR 3.13 (22.8–105.2) for collapsed compared with normal weakness), and jaundice (OR 12.8 (4.06–40.2)). Severity scoring predictive ability was 74.4% in adults and 83.4% in children and adolescents.ConclusionOur evidenced-based severity scoring system demonstrated sufficient predictive ability to be operationalised as a clinical tool for rational allocation of treatment to VL patients at MSF centres in South Sudan.

Visceral Leishmaniasis: Evaluation of Diagnostic Tools, Therapeutic Regimens, and Associated Risk Factors in Areas with Frequent Outbreaks in South Sudan and Sudan: Case Reports and Review of Literature

“…In addition to that, the population living in endemic zones stand at higher risk and exposure to infection than those in non-endemic areas [52]. People living with HIV and other immune-compromised person face the risk [24]. Natural responses, re-infection, healing, and posttreatment enhances stable immunity among people living in endemic areas.…”

“…The case fatality of VL could exceed more than 95% in occurrence within 2 years' time [23]. According to the various reports, six endemic countries: namely Brazil, Ethiopia, India, Somalia, South Sudan, and Sudan are observed to contribute 90% of global disease incidence [24]. According to Al Salem et al [25], the Eastern African countries of Kenya, South Sudan, Uganda, Sudan, Ethiopia and Somalia are badly stricken by VL in sub-Saharan Africa, where sand flies densely colonize the region with different subgenera of Phlebotomus, paraphlebotomus, synphlebotomus (martini and celiac), larroussius (Orientalis), ananaphlebotomus (rodhaini) [25].…”

“…According to Al Salem et al [25], the Eastern African countries of Kenya, South Sudan, Uganda, Sudan, Ethiopia and Somalia are badly stricken by VL in sub-Saharan Africa, where sand flies densely colonize the region with different subgenera of Phlebotomus, paraphlebotomus, synphlebotomus (martini and celiac), larroussius (Orientalis), ananaphlebotomus (rodhaini) [25]. South Sudan remains a challenging state in achieving the United Nations Sustainable Development Goals (SDGs) priorities [13,24]. It is reported that 4,175 VL cases were reported from South Sudan [24].…”

“…South Sudan remains a challenging state in achieving the United Nations Sustainable Development Goals (SDGs) priorities [13,24]. It is reported that 4,175 VL cases were reported from South Sudan [24]. Similarly, 3,810 VL and 3,011 CL were contributed by Northern Sudan in the same year [26,27].…”

“…However, SSG has been associated with toxicity such as gastrointestinal, hepatic and nephrotoxicity [3]. In pregnant women spontaneous abortion [24], is the contraindication. HIV co-infection and VL severe cases are treated with liposomal amphotericin B [28].…”