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Magnitude of unresponsiveness to sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar.
Natl Med J India. 2005 May-Jun; 18(3):131-3.NM

Abstract

BACKGROUND

The Indian government proposes to eliminate kala-azar, which has been a serious public health problem in Bihar. This study aimed to assess the magnitude of unresponsiveness to sodium stibogluconate in the treatment of new cases of visceral leishmaniasis and to identify the associated factors.

METHODS

Patients with clinically and parasitologically confirmed visceral leishmaniasis (n = 182) who had received no prior treatment, were enrolled for the study. The patients were treated with sodium stibogluconate (20 mg/kg body weight; upper limit 850 mg), intramuscularly for 30 days. The vital parameters and side-effects, if any, were monitored. Patients who developed toxicity during treatment were excluded from the study but were given rescue treatment with liposomal amphotericin B. All patients who completed the treatment were followed up for 6 months.

RESULTS

Unresponsiveness to sodium stibogluconate at the end of treatment was 43%. It was higher in women (48%) compared to men (40%). A significant association was observed between unresponsiveness and level of endemicity (p = 0.0002), large spleen size (p = 0.04) and immune response (migration inhibition factor) (p = 0.00002). At the end of 6 months' follow up, 27% of patients relapsed, giving a total unresponsiveness rate of 58%.

CONCLUSION

Unresponsiveness to sodium stibogluconate is a serious problem in the management of patients with visceral leishmaniasis. In patients with factors associated with nonresponse to sodium stibogluconate, alternative drugs such as miltefosine or amphotericin B should be considered as first-line drugs.

Authors+Show Affiliations

Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Agamkuan, Patna 800007, Bihar, India. dirrmris@sancharnet.inNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16130613

Citation

Das, V N R., et al. "Magnitude of Unresponsiveness to Sodium Stibogluconate in the Treatment of Visceral Leishmaniasis in Bihar." The National Medical Journal of India, vol. 18, no. 3, 2005, pp. 131-3.
Das VN, Ranjan A, Bimal S, et al. Magnitude of unresponsiveness to sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar. Natl Med J India. 2005;18(3):131-3.
Das, V. N., Ranjan, A., Bimal, S., Siddique, N. A., Pandey, K., Kumar, N., Verma, N., Singh, V. P., Sinha, P. K., & Bhattacharya, S. K. (2005). Magnitude of unresponsiveness to sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar. The National Medical Journal of India, 18(3), 131-3.
Das VN, et al. Magnitude of Unresponsiveness to Sodium Stibogluconate in the Treatment of Visceral Leishmaniasis in Bihar. Natl Med J India. 2005 May-Jun;18(3):131-3. PubMed PMID: 16130613.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Magnitude of unresponsiveness to sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar. AU - Das,V N R, AU - Ranjan,A, AU - Bimal,Sanjeev, AU - Siddique,N A, AU - Pandey,K, AU - Kumar,Nawin, AU - Verma,Neena, AU - Singh,V P, AU - Sinha,P K, AU - Bhattacharya,S K, PY - 2005/9/1/pubmed PY - 2005/11/3/medline PY - 2005/9/1/entrez SP - 131 EP - 3 JF - The National medical journal of India JO - Natl Med J India VL - 18 IS - 3 N2 - BACKGROUND: The Indian government proposes to eliminate kala-azar, which has been a serious public health problem in Bihar. This study aimed to assess the magnitude of unresponsiveness to sodium stibogluconate in the treatment of new cases of visceral leishmaniasis and to identify the associated factors. METHODS: Patients with clinically and parasitologically confirmed visceral leishmaniasis (n = 182) who had received no prior treatment, were enrolled for the study. The patients were treated with sodium stibogluconate (20 mg/kg body weight; upper limit 850 mg), intramuscularly for 30 days. The vital parameters and side-effects, if any, were monitored. Patients who developed toxicity during treatment were excluded from the study but were given rescue treatment with liposomal amphotericin B. All patients who completed the treatment were followed up for 6 months. RESULTS: Unresponsiveness to sodium stibogluconate at the end of treatment was 43%. It was higher in women (48%) compared to men (40%). A significant association was observed between unresponsiveness and level of endemicity (p = 0.0002), large spleen size (p = 0.04) and immune response (migration inhibition factor) (p = 0.00002). At the end of 6 months' follow up, 27% of patients relapsed, giving a total unresponsiveness rate of 58%. CONCLUSION: Unresponsiveness to sodium stibogluconate is a serious problem in the management of patients with visceral leishmaniasis. In patients with factors associated with nonresponse to sodium stibogluconate, alternative drugs such as miltefosine or amphotericin B should be considered as first-line drugs. SN - 0970-258X UR - https://www.unboundmedicine.com/medline/citation/16130613/Magnitude_of_unresponsiveness_to_sodium_stibogluconate_in_the_treatment_of_visceral_leishmaniasis_in_Bihar_ L2 - http://www.diseaseinfosearch.org/result/4166 DB - PRIME DP - Unbound Medicine ER -