Single-Dose Liposomal Amphotericin B for Visceral Leishmaniasis in India

Sundar, Shyam; Chakravarty, Jaya; Agarwal, Dipti; Rai, Madhukar; Murray, Henry W.

doi:10.1056/nejmoa0903627

Cited by 384 publications

(279 citation statements)

References 18 publications

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“…Visceral leishmaniasis may be the first infection related in 13% up to 47% of HIV-infected patients 22,24 . It is important to make an early diagnosis and monitor the development of leishmaniasis in HIV-infected patients, since these cases are less responsive to treatment and have higher fatality rates 30 .…”

Section: Discussionmentioning

confidence: 99%

“…Several reasons have been cited for the limited sensitivity: a low number of Leishmania-infected cells as a consequence of pancytopenia; a hemodiluted sample due to inadequate collection or a low parasite load when the patient has already started therapy 20,30 . Patient six tested negative for Leishmania, but presented positive results with DAT and KAtex.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil

Cavalcanti

Medeiros

Lopes

et al. 2012

Rev. Inst. Med. trop. S. Paulo

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HIV/AIDS-associated visceral leishmaniasis may display the characteristics of an aggressive disease or without specific symptoms at all, thus making diagnosis difficult. The present study describes the results of diagnostic tests applied to a series of suspected VL cases in HIV-infected/AIDS patients admitted in referral hospitals in Pernambuco, Brazil. From a total of 14 eligible patients with cytopenias and/or fever of an unknown etiology, and indication of bone marrow aspirate, 10 patients were selected for inclusion in the study. Diagnosis was confirmed by the following examinations: Leishmania detection in bone marrow aspirate, direct agglutination test, indirect immunofluorescence, rK39 dipstick test, polymerase chain reaction and latex agglutination test. Five out of the ten patients were diagnosed with co-infection. A positive direct agglutination test was recorded for all five co-infected patients, the Leishmania detection and latex agglutination tests were positive in four patients, the rK39 dipstick test in three, the indirect immunofluorescence in two and a positive polymerase chain reaction was recorded for one patient. This series of cases was the first to be conducted in Brazil using this set of tests in order to detect co-infection. However, no consensus has thus far been reached regarding the most appropriate examination for the screening and monitoring of this group of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil

Cavalcanti

Medeiros

Lopes

et al. 2012

Rev. Inst. Med. trop. S. Paulo

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“…Researchers evaluated the efficacy and safety of L-AmB in the treatment of VL especially in endemic countries, with no significant reports of nephrotoxicity or other adverse events [20][21][22][23]. It should be noted however that in none of these studies were patients submitted to frequent monitoring of renal function during the initial period of treatment (i.e.…”

Section: Discussionmentioning

confidence: 99%

Subclinical tumor lysis-like syndrome during treatment of visceral leishmaniasis with low-dose intermittent liposomal amphotericin B

2012

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AbstractWe retrospectively evaluated the rate of renal dysfunction during treatment with liposomal amphotericin B (L-AmB) (3–4 mg/kg, for 7–10 days) in nine consecutive patients with visceral leishmaniasis (VL). During the first week of treatment, 5 patients (56%) experienced transient deterioration of renal function, with a rise in serum creatinine to 1.27–2.44 times the baseline level, and a parallel elevation of uric acid levels without other metabolic or electrolyte disturbances. Serum renal function parameters were restored to normal levels after the completion of therapy, on day 21. These 5 patients had presented with prolonged fever and/or significant spleen enlargement, reflecting high parasite load. This observation suggests that treatment of VL with intermittent L-AmB causes a subclinical tumor lysis-like syndrome, especially in patients with high parasite load.

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“…The formulation shows lower nephrotoxicity as compared to AmB deoxycholate, allowing its use at high doses (Cesaro et al, 1999). However, anaphylactic reactions, which were less frequent than with the use of AmB deoxycholate, occurred with its use Sundar et al, 2010;Janknegt et al, 1992). Anaphylactic reactions are mediated by the release of histamine and are reactions with an allergic character (Cesaro et al, 1999).…”

Section: Challenges Of Antifungal Therapy With Amphotericin Bmentioning

confidence: 99%

Difficulties in antifungal therapy with amphotericin B and the continuous search for new formulations: A literature review

Voncik¹,

Fermino²,

Cardoso³

et al. 2016

Afr. J. Pharm. Pharmacol.

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Despite advances in the research on new antifungal agents, Amphotericin B (AmB) is still considered as the antifungal of choice for treating most systemic mycoses due to its potency and broad-spectrum action. However, this drug has limited use because of its toxic effects on kidneys, liver and blood. The search for new and safe formulations of AmB is essential because of the emergence of antifungal resistance to other drugs and the increased number of immunosuppressed patients. Nanoparticles are a promising alternative towards achieving lower toxicity and improved pharmacokinetic properties. This study is a literature review of the use of AmB and the toxicity of formulations. Some of the current new formulations show some advantageous characteristics as compared to AmB. However, there is still need for a continued search for an effectively improved formulation.

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Single-Dose Liposomal Amphotericin B for Visceral Leishmaniasis in India

Abstract: A single infusion of liposomal amphotericin B was not inferior to and was less expensive than conventional therapy with amphotericin B deoxycholate. (ClinicalTrials.gov number, NCT00628719.)

Cited by 384 publications

References 18 publications

Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil

Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil

Subclinical tumor lysis-like syndrome during treatment of visceral leishmaniasis with low-dose intermittent liposomal amphotericin B

Difficulties in antifungal therapy with amphotericin B and the continuous search for new formulations: A literature review

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