scholarly journals Liposomal amphotericin B for complicated visceral leishmaniasis (kala-azar) in eastern Sudan: how effective is treatment for this neglected disease?

2014 ◽  
Vol 19 (2) ◽  
pp. 146-152 ◽  
Author(s):  
Niven A. Salih ◽  
Johan van Griensven ◽  
François Chappuis ◽  
Annick Antierens ◽  
Ann Mumina ◽  
...  
2021 ◽  
Vol 8 (5) ◽  
pp. 69-72
Author(s):  
Pavankumar Narapaka ◽  
Kalpana Katikala

The complication of visceral leishmaniasis is post-kala-azar dermal leishmaniasis (PKDL). PKDL typically occurs as a result of treatment failure or parasite resistance to treatment regimens, as well as poor patient follow-up. In the treatment of visceral leishmaniasis and post-kala-azar dermal leishmaniasis, Liposomal Amphotericin B is considering as first-line therapy. We're going to show you a case where Liposomal Amphotericin B was used to treat it. Keywords: visceral leishmaniasis, post-kala-azar dermal leishmaniasis, PKDL, kala-azar


2014 ◽  
Vol 8 (1) ◽  
pp. e2611 ◽  
Author(s):  
Sakib Burza ◽  
Prabhat Kumar Sinha ◽  
Raman Mahajan ◽  
Marta González Sanz ◽  
María Angeles Lima ◽  
...  

Author(s):  
Srija Moulik ◽  
Ritika Sengupta ◽  
Manab Kumar Ghosh ◽  
Nilay Kanti Das ◽  
Bibhuti Saha ◽  
...  

Background: Post kala-azar dermal leishmaniasis (PKDL) is thought to be the reservoir of infection for visceral leishmaniasis in South Asia. The development of strategies for the diagnosis and treatment of PKDL are important for the implementation of the visceral leishmaniasis elimination program. Aims: Liposomal amphotericin B (L-AMB) has been an overwhelming success in the treatment of visceral leishmaniasis. However, the empirical three-week regimen of L-AMB proposed for PKDL was shown to be inadequate, especially in the macular variant. This study aimed to delineate response of the different variants of PKDL to L-AMB. Methods: Skin biopsies were collected from PKDL cases at disease presentation and upon completion of treatment with L-AMB. Parasite DNA was detected by Internal Transcribed Spacer-1 PCR (ITS-1 PCR) and quantified by amplification of parasite kDNA. CD68 + macrophages were estimated in tissue sections by immunohistochemistry. Results: Treatment with L-AMB decreased the parasite load by 97% in polymorphic cases but only by 45% in macular cases. The median parasite load (89965 vs 5445 parasites/μg of genomic DNA) as well as infiltration by CD68+ cells before treatment was much greater in the polymorphic cases. Limitations: Although monitoring of the parasite load for 12 months post-treatment would have been ideal, this was not possible owing to logistical issues as well as the invasive nature of biopsy collection procedure. Conclusion: A dramatic decrease in the parasite burden was noted in patients with polymorphic lesions. Although patients with macular disease also had a decrease in parasite burden, this was not as marked as in the polymorphic cases. There was also a significantly greater infiltration of CD68 + macrophages in polymorphic PKDL before therapy.


2019 ◽  
Vol 221 (4) ◽  
pp. 608-617 ◽  
Author(s):  
V Ramesh ◽  
Keerti Kaumudee Dixit ◽  
Neha Sharma ◽  
Ruchi Singh ◽  
Poonam Salotra

Abstract Background No satisfactory canonical treatment is available for post-kala-azar dermal leishmaniasis (PKDL), clinical sequela of visceral leishmaniasis. Confined treatment options and substantial increase in relapse rate after miltefosine (MIL) treatment warrant the need to adapt resilient combination therapies. In this study, we assessed the safety and efficacy of combination therapy using liposomal amphotericin B (LAmB) and MIL for treating PKDL. Methods Thirty-two PKDL patients, confirmed by microscopy or quantitative polymerase chain reaction (qPCR), were included in the study. An equal number of cases (n = 16) were put on MIL monotherapy (100 mg/day for 90 days) or MIL and LAmB combination for 45 days (3 injections of LAmB, 5 mg/kg body weight, and 100 mg/day MIL). Parasite load in slit aspirate was monitored using qPCR. Results Patients treated with combination therapy demonstrated a rapid decline in parasite load and achieved 100% cure, with no reports of relapse. Those treated with MIL monotherapy attained clinical cure with a gradual decrease in parasite load; however, 25% relapsed within 18 months of follow-up. Conclusions Liposomal amphotericin B and MIL combination for treating PKDL is efficacious and safe, with high tolerability. Furthermore, this study established the utility of minimally invasive slit aspirate method for monitoring of parasite load and assessment of cure in PKDL.


2019 ◽  
Vol 72 ◽  
pp. 101934 ◽  
Author(s):  
Mahmoud Khodabandeh ◽  
Ali Rostami ◽  
Katayoun Borhani ◽  
H. Ray Gamble ◽  
Mohsen Mohammadi

1997 ◽  
Vol 131 (2) ◽  
pp. 271-277 ◽  
Author(s):  
Lucio di Martino ◽  
Robert N. Davidson ◽  
Raffella Giacchino ◽  
Silvestro Scotti ◽  
Francesco Raimondi ◽  
...  

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