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Efficacy of liposomal amphotericin B (AmBisome) in the treatment of persistent post-kala-azar dermal leishmaniasis (PKDL).
Ann Trop Med Parasitol. 2005 Sep; 99(6):563-9.AT

Abstract

A dermatosis commonly known as post-kala-azar dermal leishmaniasis (PKDL) may develop following the treatment of human visceral leishmaniasis (VL). In about 15% of PKDL cases the disfiguring lesions persist, sometimes for many years. Such persistent lesions currently require daily injections of sodium stibogluconate (SSG) for 2-4 months and even then treatment may not be successful. Alternative, quicker and cheaper treatment options that cause less toxicity are being explored. Immuno-chemotherapeutic regimens (based on leishmaniasis candidate vaccines/BCG with SSG) are still experimental but treatment with liposomal amphotericin B (AmBisome) has already been found effective, albeit in a small number of patients. AmBisome is considered less nephrotoxic than non-liposomal amphotericin B because it specifically targets the macrophages in which the Leishmania parasites develop. The aim of the present study was to evaluate further the usefulness of AmBisome in the treatment of persistent PKDL, in Sudan. The 12 subjects, all of whom gave their informed consent, had each had PKDL lesions for >6 months and shown no improvement after repeated injections of SSG. During the study period, they were hospitalized and regularly screened, haematologically and biochemically, for adverse effects. The AmBisome, given intravenously at 2.5 mg/kg.day for 20 days, completely cleared the skin rash of 10 (83%) of the patients and caused no detectable adverse effects. In the 10 patients who responded well to the treatment, the papular lesions regressed and became flat while the hypopigmented lesions darkened (continuing to do so even after the last AmBisome injections). Treatment outcome appeared to be unaffected by the age or gender of the patient (P = 0.7 for each) but the time taken for the PKDL lesions to heal was correlated with the age of the lesions (P = 0.009). The macular lesions healed more slowly than the papular (P = 0.02). In conclusion, Ambisome appears suitable for the treatment of persistent PKDL lesions in Sudan. Once certain favourable clinical signs (the regression and/or darkening of the PKDL lesions) have been noted, the lesions will probably continue to clear without the need for more injections.

Authors+Show Affiliations

Department of Clinical Pathology and Immunology, Institute of Endemic Diseases, University of Khartoum, Sudan. amusa@iend.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16156969

Citation

Musa, A M., et al. "Efficacy of Liposomal Amphotericin B (AmBisome) in the Treatment of Persistent Post-kala-azar Dermal Leishmaniasis (PKDL)." Annals of Tropical Medicine and Parasitology, vol. 99, no. 6, 2005, pp. 563-9.
Musa AM, Khalil EA, Mahgoub FA, et al. Efficacy of liposomal amphotericin B (AmBisome) in the treatment of persistent post-kala-azar dermal leishmaniasis (PKDL). Ann Trop Med Parasitol. 2005;99(6):563-9.
Musa, A. M., Khalil, E. A., Mahgoub, F. A., Hamad, S., Elkadaru, A. M., & El Hassan, A. M. (2005). Efficacy of liposomal amphotericin B (AmBisome) in the treatment of persistent post-kala-azar dermal leishmaniasis (PKDL). Annals of Tropical Medicine and Parasitology, 99(6), 563-9.
Musa AM, et al. Efficacy of Liposomal Amphotericin B (AmBisome) in the Treatment of Persistent Post-kala-azar Dermal Leishmaniasis (PKDL). Ann Trop Med Parasitol. 2005;99(6):563-9. PubMed PMID: 16156969.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of liposomal amphotericin B (AmBisome) in the treatment of persistent post-kala-azar dermal leishmaniasis (PKDL). AU - Musa,A M, AU - Khalil,E A G, AU - Mahgoub,F A, AU - Hamad,S, AU - Elkadaru,A M Y, AU - El Hassan,A M, PY - 2005/9/15/pubmed PY - 2005/11/3/medline PY - 2005/9/15/entrez SP - 563 EP - 9 JF - Annals of tropical medicine and parasitology JO - Ann Trop Med Parasitol VL - 99 IS - 6 N2 - A dermatosis commonly known as post-kala-azar dermal leishmaniasis (PKDL) may develop following the treatment of human visceral leishmaniasis (VL). In about 15% of PKDL cases the disfiguring lesions persist, sometimes for many years. Such persistent lesions currently require daily injections of sodium stibogluconate (SSG) for 2-4 months and even then treatment may not be successful. Alternative, quicker and cheaper treatment options that cause less toxicity are being explored. Immuno-chemotherapeutic regimens (based on leishmaniasis candidate vaccines/BCG with SSG) are still experimental but treatment with liposomal amphotericin B (AmBisome) has already been found effective, albeit in a small number of patients. AmBisome is considered less nephrotoxic than non-liposomal amphotericin B because it specifically targets the macrophages in which the Leishmania parasites develop. The aim of the present study was to evaluate further the usefulness of AmBisome in the treatment of persistent PKDL, in Sudan. The 12 subjects, all of whom gave their informed consent, had each had PKDL lesions for >6 months and shown no improvement after repeated injections of SSG. During the study period, they were hospitalized and regularly screened, haematologically and biochemically, for adverse effects. The AmBisome, given intravenously at 2.5 mg/kg.day for 20 days, completely cleared the skin rash of 10 (83%) of the patients and caused no detectable adverse effects. In the 10 patients who responded well to the treatment, the papular lesions regressed and became flat while the hypopigmented lesions darkened (continuing to do so even after the last AmBisome injections). Treatment outcome appeared to be unaffected by the age or gender of the patient (P = 0.7 for each) but the time taken for the PKDL lesions to heal was correlated with the age of the lesions (P = 0.009). The macular lesions healed more slowly than the papular (P = 0.02). In conclusion, Ambisome appears suitable for the treatment of persistent PKDL lesions in Sudan. Once certain favourable clinical signs (the regression and/or darkening of the PKDL lesions) have been noted, the lesions will probably continue to clear without the need for more injections. SN - 0003-4983 UR - https://www.unboundmedicine.com/medline/citation/16156969/Efficacy_of_liposomal_amphotericin_B__AmBisome__in_the_treatment_of_persistent_post_kala_azar_dermal_leishmaniasis__PKDL__ L2 - http://www.diseaseinfosearch.org/result/4166 DB - PRIME DP - Unbound Medicine ER -