Unresponsiveness to AmBisome in some Sudanese patients with kala-azar.

Hdl Handle:
http://hdl.handle.net/10144/18262
Title:
Unresponsiveness to AmBisome in some Sudanese patients with kala-azar.
Authors:
Mueller, M; Ritmeijer, K; Balasegaram, M; Koummuki, Y; Santana, M R; Davidson, R N
Journal:
Transactions of the Royal Society of Tropical Medicine and Hygiene
Abstract:
In Sudan, two treatments are currently registered for visceral leishmaniasis: sodium stibogluconate (SSG) as first line and liposomal amphotericin B (AmBisome) as second line. We present 64 patients (52 relapse cases to SSG, 12 new but complicated cases) treated with AmBisome in eastern Sudan. AmBisome was administered at 2.5-8.2mg/kg (15-49mg/kg in total) per dose six times (days 1, 2, 3, 5, 10, 15) as an intravenous infusion. We measured outcome according to clinical response and parasitological clearance (lymph node aspiration). Patient outcomes fell into three groups: group 1, clinical responders (cured) with a negative test of cure (n=35); group 2, clinical responders with a positive test of cure (n=19); group 3, clinical non-responders (failures) with a positive test of cure (n=10). Of the 10 failures, six were already relapse cases. All of group 3, and 15 from group 2, were also treated with additional SSG (20mg/kg intramuscularly daily for 30-50 d) with resulting clinical and parasitological improvement. Parasite persistence and clinical failure were associated with a higher parasite density on admission (P<0.002) and underlying immunosuppressive disease: tuberculosis (three cases) or HIV (two cases). Because AmBisome monotherapy may fail in Sudan, a combination of AmBisome and SSG is recommended for relapse cases.
Affiliation:
Medécins Sans Frontières, Plantage Middenlaan 14, 1018 DD Amsterdam, The Netherlands.
Publisher:
Elsevier
Issue Date:
Jan-2007
URI:
http://hdl.handle.net/10144/18262
DOI:
10.1016/j.trstmh.2006.02.005
PubMed ID:
16730363
Additional Links:
http://www.sciencedirect.com/science/journal/00359203
Language:
en
ISSN:
0035-9203
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorMueller, M-
dc.contributor.authorRitmeijer, K-
dc.contributor.authorBalasegaram, M-
dc.contributor.authorKoummuki, Y-
dc.contributor.authorSantana, M R-
dc.contributor.authorDavidson, R N-
dc.date.accessioned2008-02-14T11:25:17Z-
dc.date.available2008-02-14T11:25:17Z-
dc.date.issued2007-01-
dc.identifier.citationUnresponsiveness to AmBisome in some Sudanese patients with kala-azar. 2007, 101 (1):19-24 Trans. R. Soc. Trop. Med. Hyg.en
dc.identifier.issn0035-9203-
dc.identifier.pmid16730363-
dc.identifier.doi10.1016/j.trstmh.2006.02.005-
dc.identifier.urihttp://hdl.handle.net/10144/18262-
dc.description.abstractIn Sudan, two treatments are currently registered for visceral leishmaniasis: sodium stibogluconate (SSG) as first line and liposomal amphotericin B (AmBisome) as second line. We present 64 patients (52 relapse cases to SSG, 12 new but complicated cases) treated with AmBisome in eastern Sudan. AmBisome was administered at 2.5-8.2mg/kg (15-49mg/kg in total) per dose six times (days 1, 2, 3, 5, 10, 15) as an intravenous infusion. We measured outcome according to clinical response and parasitological clearance (lymph node aspiration). Patient outcomes fell into three groups: group 1, clinical responders (cured) with a negative test of cure (n=35); group 2, clinical responders with a positive test of cure (n=19); group 3, clinical non-responders (failures) with a positive test of cure (n=10). Of the 10 failures, six were already relapse cases. All of group 3, and 15 from group 2, were also treated with additional SSG (20mg/kg intramuscularly daily for 30-50 d) with resulting clinical and parasitological improvement. Parasite persistence and clinical failure were associated with a higher parasite density on admission (P<0.002) and underlying immunosuppressive disease: tuberculosis (three cases) or HIV (two cases). Because AmBisome monotherapy may fail in Sudan, a combination of AmBisome and SSG is recommended for relapse cases.en
dc.language.isoenen
dc.publisherElsevier-
dc.relation.urlhttp://www.sciencedirect.com/science/journal/00359203-
dc.rightsArchived on this site with the kind permission of Elsevier Ltd. and the Royal Society of Tropical Medicine and Hygiene, http://www.rstmh.org/transactions.aspen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAmphotericin Ben
dc.subject.meshAntiprotozoal Agentsen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshDose-Response Relationship, Drugen
dc.subject.meshFemaleen
dc.subject.meshHIV Infectionsen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshInfusions, Intravenousen
dc.subject.meshLeishmaniasis, Visceralen
dc.subject.meshMaleen
dc.subject.meshRisk Factorsen
dc.subject.meshTreatment Failureen
dc.subject.meshTuberculosisen
dc.titleUnresponsiveness to AmBisome in some Sudanese patients with kala-azar.en
dc.contributor.departmentMedécins Sans Frontières, Plantage Middenlaan 14, 1018 DD Amsterdam, The Netherlands.en
dc.identifier.journalTransactions of the Royal Society of Tropical Medicine and Hygieneen

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