scholarly journals IgG3 and IL10 are effective biomarkers for monitoring therapeutic effectiveness in Post Kala-Azar Dermal Leishmaniasis

2021 ◽  
Vol 15 (11) ◽  
pp. e0009906
Author(s):  
Shilpa Sengupta ◽  
Mitali Chatterjee
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Igg Subclasses ◽  
Liposomal Amphotericin B ◽  
Therapeutic Effectiveness ◽  
Non Invasive ◽  
Kala Azar ◽  
End Of Treatment ◽  
Time Point

Background The assessment of chemotherapeutic responses in Post Kala-azar Dermal Leishmaniasis (PKDL), especially its macular form is challenging, emphasizing the necessity for ‘test of cure’ tools. This study explored the diagnostic and prognostic potential of IgG subclasses and associated cytokines for monitoring the effectiveness of chemotherapy in PKDL. Methods Participants included PKDL cases at (a) disease presentation, (b) immediately at the end of treatment (12 weeks for Miltefosine or 3 weeks for Liposomal Amphotericin B, LAmB and (c) at any time point 6 months later, for estimating anti-leishmanial immunoglobulin (Ig, IgG, IgM, IgG1, IgG2 and IgG3) and cytokines (IL-10, IL-6). Results In PKDL, Ig levels were elevated, with IgG3 and IL-10 being the major contributors. Miltefosine decreased both markers substantially and this decrease was sustained for at least six months. In contrast, LAmB failed to decrease IgG3 and IL-10, as even after six months, their levels remained unchanged or even increased. Conclusions In PKDL, IgG3 and IL-10 proved to be effective predictors of responsiveness to chemotherapy and may be considered as a non invasive alternative for longitudinal monitoring.

Assessing the Efficacy and Safety of Liposomal Amphotericin B and Miltefosine in Combination for Treatment of Post Kala-Azar Dermal Leishmaniasis

2019 ◽  
Vol 221 (4) ◽  
pp. 608-617 ◽  
Author(s):  
V Ramesh ◽  
Keerti Kaumudee Dixit ◽  
Neha Sharma ◽  
Ruchi Singh ◽  
Poonam Salotra
Keyword(s):  
Combination Therapy ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Quantitative Polymerase Chain Reaction ◽  
Treatment Options ◽  
Parasite Load ◽  
Liposomal Amphotericin B ◽  
Rapid Decline ◽  
Kala Azar

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.

Treatment experience with liposomal amphotericin B in pediatric patients with kala-azar

2015 ◽  
Vol 4 (3) ◽  
pp. 222-229
Author(s):  
Can Acıpayam ◽  
Gülnaz Çulha ◽  
Ali Altunay ◽  
Fazilet Akoğlu ◽  
Alkan Yeral ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Pediatric Patients ◽  
Liposomal Amphotericin B ◽  
Treatment Experience ◽  
Kala Azar

scholarly journals Post kala-azar dermal leishmaniasis treated with liposomal amphotericin B (AmBisome)

2016 ◽  
Vol 45 ◽  
pp. 61
Author(s):  
S. Burza ◽  
M.D. Boer ◽  
R. Mahajan ◽  
A.K. Das ◽  
G. Mitra ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
Kala Azar

scholarly journals Treatment of post kala-azar dermal leishmaniasis with fungisome – A novel Indian liposomal amphotericin B

2020 ◽  
Vol 6 (1) ◽  
pp. 28
Author(s):  
NilimaA Kshirsagar ◽  
AkanshaAnil Chadha ◽  
Vidya Kharkar ◽  
Uday Khopkar ◽  
Bhushan Darkase ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
Kala Azar

scholarly journals Meglumine antimoniate combination treatment for relapsing Kala-azar after treatment and secondary prophylaxis failure with liposomal amphotericin B in two HIV-coinfected patients

2019 ◽  
Vol 12 (12) ◽  
pp. e231929
Author(s):  
Lara Camara ◽  
João Queirós ◽  
Rita Ribeiro ◽  
Eugénio Teófilo
Keyword(s):  
Immune Response ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Combined Therapy ◽  
Secondary Prophylaxis ◽  
Response To Treatment ◽  
Liposomal Amphotericin B ◽  
Meglumine Antimoniate ◽  
Kala Azar ◽  
Protozoan Infection

Visceral leishmaniasis (VL) is a protozoan infection caused by Leishmania infantum and L. donovani with a higher incidence and severity in HIV-infected patients due to its synergistic effect on hampering the immune response, often leading to death after treatment failure. Literature regarding the management of relapsing VL in HIV-coinfected patients is lacking. Many experts recommend a combined therapy with liposomal amphotericin B and miltefosine. The use of pentavalent antimonials is often discouraged due to their toxicity. We report two cases of successful response to treatment with combined therapy with meglumine antimoniate followed by secondary prophylaxis with miltefosine and atovaquone on relapsing VL in two HIV-coinfected patients despite treatment and monthly prophylaxis with appropriate doses of liposomal amphotericin B.

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