Liposomal Amphotericin B for Visceral Leishmaniasis in a Kidney Allograft Patient

Abstract

Objective To report a case of visceral leishmaniasis treated with liposomal amphotericin B (LAB) after probable failure with amphotericin B lipid complex (ABLC). Case Summary A 62-year-old white renal transplant recipient was admitted for pyrexia, hepato-splenomegaly, and pancytopenia. Leishmania amastigotes were detected from bone marrow aspirate and in circulating blood monocytes and neutrophils. The patient, who weighed 56 kg, received ABLC at a starting dose of 200 mg/d (3.6 mg/kg of body weight per day) for 13 days, achieving a total dose of 2,600 mg (46 mg/kg) without clinical improvement. The patient was switched to 100 mg/d (1.8 mg/kg) of LAB for 10 days, after which a dose of 250 mg (4.5 mg/kg) was repeated on days 17,24,31, and 38. Twenty-four hours after the first dose of LAB, the patient showed an excellent clinical response. On the following days, there was a progressive increase in hemoglobin concentration and leukocyte and platelet counts. Three months later, the patient was asymptomatic. Discussion Although treatment with ABLC appears to be effective for the treatment of Indian patients with visceral leishmaniasis, experience with immunocompromised patients is limited. This is the first case of a renal transplant recipient in which ABLC was used to treat visceral leishmaniasis without remarkable efficacy, but with infusion-related adverse effects perhaps due to the use of higher doses. Conclusions A randomized comparative trial is needed to compare LAB with ABLC in the treatment of visceral leishmaniasis in patients who have received kidney allografts.

Epidemiology, Clinical Characteristics, Diagnostic Work Up, and Treatment Options of Leishmania Infection in Kidney Transplant Recipients: A Systematic Review

“…At the end of the process, we included 66 retrospective case reports and 4 retrospective case series. According to the modified Newcastle–Ottawa Scale, 11 items were classified as low-quality [ 7 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ], 34 as average-quality [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], and 25 as high-quality studies [ 4 , 10 , 59 , 60 , 61 …”

“…Information regarding the country of origin or travel activity was available for 153/159 (96.2%) patients. The vast majority ( n = 143) of KT recipients with Leishmaniasis came from or had travelled to endemic regions, especially South America, North Africa, the Middle East, India, or the Mediterranean basin [ 4 , 16 , 17 , 18 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 34 , 35 , 36 , 38 , 40 , 41 , 42 , 44 , 45 , 48 , 50 , 51 , 52 , 54 , 55 , 56 , 57 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 69 , 70 , 71 , 72 , 73 , 75 , 76 , 78 , 79 , 81 …”

“…Most episodes of Leishmania infection were registered in Brazil ( n = 66) [ 22 , 29 , 30 , 40 , 58 , 68 , 74 , 79 ]. Several cases were also reported in the Mediterranean basin ( n = 61), such as Spain ( n = 20) [ 18 , 27 , 36 , 41 , 48 , 53 , 55 , 61 , 63 , 68 , 78 ], Italy ( n = 14) [ 31 , 33 , 35 , 42 , 44 , 45 , 51 , 72 , 81 ], France ( n = 10) [ 25 , 39 , 64 ], Tunisia ( n = 8) [ 7 , 17 , 34 , 52 , 62 , 69 ], Greece ( n = 4) [ 54 ], Turkey ( n = 3) [ 59 , 67 , 77 ], Malta ( n = 1) [ 38 ], and Algeria ( n = 1) [ 23 ]. Overall, European countries outside the Mediterranean basin recorded a small number of infections: Portugal ( n = 2) [ 24 , 66 ], Switzerland ( n ...…”

“…Data regarding ethnicity were available for 81/159 (50.9%) recipients [ 4 , 7 , 10 , 19 , 22 , 25 , 26 , 28 , 29 , 30 , 33 , 35 , 37 , 38 , 39 , 42 , 43 , 45 , 52 , 58 , 61 , 66 , 68 , 70 , 73 , 75 , 80 ]. The most represented heritages were Caucasian ( n = 45) [ 10 , 19 , 22 , 25 , 30 , 33 , 35 , 37 , 38 , 39 , 42 , 43 , 45 , 52 , 61 , 66 , 68 , 70 , 73 , 75 , 80 ] and Afro-Caribbean ( n = 30) [ 7 , 10 , …”

“…Patients’ age ranged from 12 to 76 years, with a single pediatric case [ 23 ] and 18 recipients older than 60 years [ 10 , 17 , 31 , 33 , 35 , 47 , 58 , 63 , 64 , 66 , 70 , 72 , 73 , 75 , 81 ]. In the study by Alves da Silva et al [ 22 ] enrolling 20 patients, the mean age at diagnosis was 37 (±10.7) years.…”