Vélez Iván Darío, Colmenares Lina María, Muñoz Carlos Aguirre
Programa de Estudio y Control de Enfermedades Tropicales, Universidad de Antioquia, Medellín, Colombia.
Rev Inst Med Trop Sao Paulo. 2009 Jul-Aug;51(4):231-6. doi: 10.1590/s0036-46652009000400011.
Visceral leishmaniasis (VL) affects over 500,000 people worldwide each year. The disease occurs in the Mediterranean basin, Central and South America and is caused by Leishmania infantum (syn L. chagasi). VL is an endemic disease in Colombia, particularly along the Caribbean coast and the Magdalena River Valley and 90% of VL cases occur in children under the age of five. The first line of treatment is chemotherapy with pentavalent antimonial compounds, including sodium stibogluconate (Pentostam) and meglumine antimoniate (Glucantime). These compounds are the ones most used in Colombia, at a dose of 20 mg/kg/day for 28 days. Nevertheless resistance of L. infantum to pentavalent antimonials is becoming an important problem. No cases of VL resistant to pentavalent antimonial compounds have previously been reported from Colombia. This report describes the two cases of VL resistance to antimonial compounds in a girl and a boy who did not respond to previous treatment with Pentacarinat and Glucantime regimens but were treated successfully with liposomal amphotericin B. Based on our findings, we recommend liposomal amphotericin B as the first line of treatment for VL due to its low toxicity, shorter administration period and the low price obtained by WHO.
内脏利什曼病（VL）每年在全球影响超过50万人。该疾病发生在地中海盆地、中美洲和南美洲，由婴儿利什曼原虫（同义名：恰加斯利什曼原虫）引起。VL在哥伦比亚是一种地方病，特别是在加勒比海岸和马格达莱纳河谷，90%的VL病例发生在五岁以下儿童中。一线治疗是使用五价锑化合物进行化疗，包括葡萄糖酸锑钠（喷他脒）和葡甲胺锑酸盐（葡糖胺锑）。这些化合物是哥伦比亚最常用的，剂量为20mg/kg/天，持续28天。然而，婴儿利什曼原虫对五价锑的耐药性正成为一个重要问题。此前哥伦比亚尚未报告过对五价锑化合物耐药的VL病例。本报告描述了一名女孩和一名男孩对五价锑化合物耐药的VL病例，他们对之前使用喷他脒和葡糖胺锑治疗方案无反应，但使用脂质体两性霉素B治疗成功。基于我们的研究结果，我们推荐脂质体两性霉素B作为VL的一线治疗药物，因为其毒性低、给药期短且世界卫生组织提供的价格较低。
