Five-Year Retrospective Italian Multicenter Study of Visceral Leishmaniasis Treatment

Abstract

9 mg/kg in immunocompetent patients, 32.9 ؎ 8.6 mg/kg in patients with non-HIV-related immunodeficiencies, and 40.8 ؎ 6.7 mg/kg in HIV-infected patients (P < 0.001). The mean numbers of infusion days were 7.8 ؎ 3.1 in immunocompetent patients, 9.6 ؎ 3.9 in non-HIV-immunodeficient patients, and 12.0 ؎ 3.4 in HIV-infected patients (P < 0.001). Mild and reversible adverse events were observed in 12.2% of cases. Responsive patients were 154 (93.3%). Successes were 98.4% among immunocompetent patients, 90.5% among non-HIV-immunodeficient patients, and 72.0% among HIV-infected patients. Among predictors of primary response to treatment, HIV infection and age held independent associations in the final multivariate models, whereas the doses and duration of L-AmB treatment were not significantly associated. Longer treatments and higher doses of L-AmB were not able to significantly modify treatment outcomes either in the immunocompetent or in the immunocompromised population.

A case of visceral leishmaniasis and pulmonary tuberculosis in a post-partum woman

“…Therapy with l-AmB confirmed its efficacy. 6 With respect to tuberculosis, Italy is considered a country with low prevalence, but the increasing immigration from countries with a high risk level (i.e. East Europe) suggests a need for increased awareness of the problem.…”

“…The complete blood count demonstrated a white blood cell count of 2850 cells/mm3, haemoglobin 11.8 g/dL, platelets 84000-111000 cells/mm3; erythrocyte sedimentation rate 48 mm/h, C-reactive protein 9.12 mg/dL and a very slight increase of gamma globulins (19.3% at the serum protein electrophoresis, range value 10, [5][6][7][8][9][10][11][12][13][14][15][16][17][18]8). Physical examination demonstrated hepatosplenomegaly, confirmed by ultrasound (spleen size approximately 20 cm).…”

The unwelcome trio: HIV plus cutaneous and visceral leishmaniasis

“…For VL, these drugs represent the first-line treatment and their recommended doses are respectively 3-5 mg/kg/day over a 3-6 days period, up to a total dose of 18-21 mg/kg, and 20 mg/kg/day for 28 days (13). For VL, these drugs represent the first-line treatment and their recommended doses are respectively 3-5 mg/kg/day over a 3-6 days period, up to a total dose of 18-21 mg/kg, and 20 mg/kg/day for 28 days (13).…”

“…Less supporting evidence exists for pentamidine or azoles, with or without allopurinol (13)(14)(15). Drug combinations seem to be promising, through shortening the courses of therapy, lowering the dosages, and diminishing the selection of resistant mutations.…”

An update on pharmacotherapy for leishmaniasis

“…A recent retrospective data analysis revealed that 98.4% immunocompetent patients, 90.5% non-HIV-immunodeficient patients, and 72.0% HIV-infected patients receiving L AmB in Italy were treated successfully. 84 A study from India in HIV-VL co- infected patients treated with L-AmB (a total dose of 20 - 25 mg/kg in 4 - 15 days) combined with antiretroviral therapy provided excellent initial response; however, relapse within 2 years remained frequent. 85 L-AmB at a total dose of 30 mg/kg in six doses on alternate days was found to be less effective in Ethiopia with initial cure of 92.6% in HIV-negative patients compared with only 59.5% in HIV-positive patients (p < 0.001), and parasitological failures in 32.3% in HIV-positive patients.…”