Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2024; 12(30): 6374-6382
Published online Oct 26, 2024. doi: 10.12998/wjcc.v12.i30.6374
Hematological picture of pediatric Sudanese patients with visceral leishmaniasis and prediction of leishmania donovani parasite load
Zeinab Ibrahim Ahmed Elnoor, Omaima Abdelmajeed, Alamin Mustafa, Thuraya Gasim, Shima Algam Mohamed Musa, Abdelrahman Hamza Abdelmoneim, Islamia Ibrahim Ahmed Omer, Hiba Awadelkareem Osman Fadl
Zeinab Ibrahim Ahmed Elnoor, Department of Pathology, Faculty of Medicine, Omdurman Ahilia University, Omdurman, Khartoum, Sudan
Zeinab Ibrahim Ahmed Elnoor, Mohammed Alamin Hamid Pediatric Hospital, Omdurman Khartoum, Sudan
Zeinab Ibrahim Ahmed Elnoor, Department of Hematology and Blood Transfusion Medicine, Federal Ministry of Health, Khartoum, Sudan
Omaima Abdelmajeed, Department of Pediatrics, Faculty of Medicine, Omdurman Islamic University, Omdurman, Khartoum, Sudan
Omaima Abdelmajeed, Tropical Diseases Teaching Hospital, Omdurman, Khartoum, Sudan
Alamin Mustafa, Shima Algam Mohamed Musa, Abdelrahman Hamza Abdelmoneim, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan
Thuraya Gasim, Faculty of Medicine, Omdurman Islamic University, Omdurman, Khartoum, Sudan
Islamia Ibrahim Ahmed Omer, Department of Pediatrics, Faculty of Medicine, University of Science and Technology, Khartoum, Sudan
Hiba Awadelkareem Osman Fadl, Department of Hematology, Faculty of Medical Laboratory Sciences, Al-Neelain University, Khartoum, Sudan
Author contributions: Elnoor ZI, Salih O A approved the study and collected the data; Mustafa A, Omer II, Salih OA, Fadl HA, Musa SA, and Elnoor ZI took the lead in writing the manuscript; Mustafa A analyzed the data and interpreted the results; Omer II, Gassim T, Musa SA, Abdelmoneim AH, and Fadl HA wrote and revised the manuscript; All authors reviewed the manuscript, provided critical feedback, and agreed on the final manuscript.
Institutional review board statement: We obtained written ethical approval from the Tropical Disease Teaching Hospital administrative authority (TDTH/B/51/1 data: 1st Jan 2021). The information acquired was kept confidential and only utilized in the context of this study.
Informed consent statement: Informed consent statement was inapplicable in retrospective study.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: Data are available upon request to the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alamin Mustafa, Doctor, Researcher, Statistical Worker, Faculty of Medicine, Al-Neelain University, 52nd St, Khartoum, Sudan. alamin900005@gmail.com
Received: March 9, 2024
Revised: July 14, 2024
Accepted: August 16, 2024
Published online: October 26, 2024
Processing time: 178 Days and 20.1 Hours
Abstract
BACKGROUND

Visceral leishmaniasis (VL) is a systemic protozoan infection caused by Leishmania donovani (L. donovani) and transmitted by sand flies, causing macrophage invasion in the liver, spleen, and bone marrow. Diagnosis of VL is currently based on clinical signs, symptoms, and specific in-vitro markers and bone marrow investigations. However, VL's specific hematological and bone marrow manifestation in Sudanese pediatric patients is not well studied.

AIM

To examine the blood and bone marrow characteristics in pediatric patients from Sudan who have VL.

METHODS

This is a retrospective hospital-based study with a sample of 107 consecutive Sudanese pediatric patients. The data focused on hematological and bone marrow results. We included only the completed records of the pediatric patients with VL in the Tropical Disease Teaching Hospital in Khartoum, Sudan from the period of 2016 to 2020.

RESULTS

The majority of pediatric patients included in this study are below 5-years-old (n = 59, 55.2%). Moreover, anemia, thrombocytopenia, and leukopenia were among the prevalent characteristics in the population under study. To further analyze the data, we developed a machine learning model using boosted forest algorithms to predict L. donovani parasites load, with a mean accuracy of 0.88 for the training dataset and an accuracy of 0.46, 0.50, and 0.74 for mild, moderate, and severe L. donovani parasite load in the validation dataset.

CONCLUSION

This study shows that the most common bone marrow change among Sudanese VL children was increased chronic inflammatory cells (n = 88, 82.2%) with present macrophage hemophagocytes (n = 103, 96.3%). While anemia and thrombocytopenia were the most common hematological changes. These results will hopefully lead to an early diagnosis and hence better management for Sudanese pediatric patients with suspected VL.

Keywords: Machine learning; Bone marrow; Hematological changes; Tropical diseases; Leishmania donovani; Visceral leishmaniasis

Core Tip: Visceral leishmaniasis (VL) is a neglected tropical disease; although many parts of Sudan are hyperendemic, many centers have very limited diagnostic capabilities and data reporting. This is one of the first studies from Sudan to investigate both hematological and bone marrow changes associated with pediatric VL and Leishmania donovani load from bone marrow biopsies. The data were collected from tertiary and specialized centers for treating VL in the country and modern analytical methods were used to describe the result for the global audience and highlight the importance of these new findings derived from a country that is hyperendemic to VL.