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Monitoring of Parasite Kinetics in Indian Post-Kala-azar Dermal Leishmaniasis.
Clin Infect Dis. 2018 01 18; 66(3):404-410.CI

Abstract

Background

The potential reservoirs of leishmaniasis in South Asia include relapsed cases of visceral leishmaniasis (VL), patients with post-kala-azar dermal leishmaniasis (PKDL), and an asymptomatically infected population. Therefore, assessment of cure in terms of parasite clearance, early detection of PKDL, and asymptomatic VL are pivotal for ensuring elimination. This study aimed to monitor the efficacy of miltefosine and liposomal amphotericin B (LAmB) in PKDL based on parasite load.

Methods

Patients with PKDL were recruited from the dermatology outpatient departments or during active field surveys. Skin biopsies were collected at disease presentation, immediately at the end of treatment, and 6 months later. The presence of parasite DNA was assessed by internal transcribed spacer-1 polymerase chain reaction, and quantified by amplification of parasite kinetoplastid DNA.

Results

At disease presentation (n = 184), the median parasite load was 5229 (interquartile range [IQR], 896-50898)/μg genomic DNA (gDNA). Miltefosine cleared the parasites to <10 in the macular (n = 17) and polymorphic (n = 21) variants, and remained so up to 6 months later (<10 parasites). LAmB reduced the parasite burden substantially in macular (n = 34; 2128 [IQR, 544-5763]/µg gDNA) and polymorphic PKDL (n = 36; 2541 [IQR, 650-9073]/µg gDNA). Importantly, in patients who returned 6 months later (n = 38), a resurgence of parasites was evident, as the parasites increased to 5665 (IQR, 1840-17067)/µg gDNA.

Conclusions

This study established that quantifying parasite load is an effective approach for monitoring patients with PKDL, wherein miltefosine demonstrated near-total parasite clearance and resolution of symptoms. However, in cases treated with LAmB, the persistence of parasites suggested treatment inadequacy. This needs immediate redressal in view of the leishmaniasis elimination program targeted for 2020.

Authors+Show Affiliations

Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India.Ranaghat S.D. Hospital, Kolkata, India.Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India.Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India.Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India.Department of Dermatology, Calcutta Medical College, Kolkata, India.Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India.

Pub Type(s)

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

Language

eng

PubMed ID

29020350

Citation

Moulik, Srija, et al. "Monitoring of Parasite Kinetics in Indian Post-Kala-azar Dermal Leishmaniasis." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 66, no. 3, 2018, pp. 404-410.
Moulik S, Chaudhuri SJ, Sardar B, et al. Monitoring of Parasite Kinetics in Indian Post-Kala-azar Dermal Leishmaniasis. Clin Infect Dis. 2018;66(3):404-410.
Moulik, S., Chaudhuri, S. J., Sardar, B., Ghosh, M., Saha, B., Das, N. K., & Chatterjee, M. (2018). Monitoring of Parasite Kinetics in Indian Post-Kala-azar Dermal Leishmaniasis. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 66(3), 404-410. https://doi.org/10.1093/cid/cix808
Moulik S, et al. Monitoring of Parasite Kinetics in Indian Post-Kala-azar Dermal Leishmaniasis. Clin Infect Dis. 2018 01 18;66(3):404-410. PubMed PMID: 29020350.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monitoring of Parasite Kinetics in Indian Post-Kala-azar Dermal Leishmaniasis. AU - Moulik,Srija, AU - Chaudhuri,Surya Jyati, AU - Sardar,Bikash, AU - Ghosh,Manab, AU - Saha,Bibhuti, AU - Das,Nilay Kanti, AU - Chatterjee,Mitali, PY - 2017/07/18/received PY - 2017/09/12/accepted PY - 2017/10/12/pubmed PY - 2019/10/23/medline PY - 2017/10/12/entrez KW - ITS1-PCR KW - liposomal amphotericin B KW - miltefosine KW - parasite load KW - post–kala-azar dermal leishmaniasis SP - 404 EP - 410 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 66 IS - 3 N2 - Background: The potential reservoirs of leishmaniasis in South Asia include relapsed cases of visceral leishmaniasis (VL), patients with post-kala-azar dermal leishmaniasis (PKDL), and an asymptomatically infected population. Therefore, assessment of cure in terms of parasite clearance, early detection of PKDL, and asymptomatic VL are pivotal for ensuring elimination. This study aimed to monitor the efficacy of miltefosine and liposomal amphotericin B (LAmB) in PKDL based on parasite load. Methods: Patients with PKDL were recruited from the dermatology outpatient departments or during active field surveys. Skin biopsies were collected at disease presentation, immediately at the end of treatment, and 6 months later. The presence of parasite DNA was assessed by internal transcribed spacer-1 polymerase chain reaction, and quantified by amplification of parasite kinetoplastid DNA. Results: At disease presentation (n = 184), the median parasite load was 5229 (interquartile range [IQR], 896-50898)/μg genomic DNA (gDNA). Miltefosine cleared the parasites to <10 in the macular (n = 17) and polymorphic (n = 21) variants, and remained so up to 6 months later (<10 parasites). LAmB reduced the parasite burden substantially in macular (n = 34; 2128 [IQR, 544-5763]/µg gDNA) and polymorphic PKDL (n = 36; 2541 [IQR, 650-9073]/µg gDNA). Importantly, in patients who returned 6 months later (n = 38), a resurgence of parasites was evident, as the parasites increased to 5665 (IQR, 1840-17067)/µg gDNA. Conclusions: This study established that quantifying parasite load is an effective approach for monitoring patients with PKDL, wherein miltefosine demonstrated near-total parasite clearance and resolution of symptoms. However, in cases treated with LAmB, the persistence of parasites suggested treatment inadequacy. This needs immediate redressal in view of the leishmaniasis elimination program targeted for 2020. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/29020350/Monitoring_of_Parasite_Kinetics_in_Indian_Post_Kala_azar_Dermal_Leishmaniasis_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cix808 DB - PRIME DP - Unbound Medicine ER -