The Leishmaniasis Research Group, Institute of Endemic Diseases, University of Khartoum, Sudan ; Department of Clinical Pathology and Immunology, Institute of Endemic Diseases, University of Khartoum, P.O. Box 102, Sudan.
J Trop Med. 2013;2013:708391. doi: 10.1155/2013/708391. Epub 2013 Apr 15.
Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis that affects more than 50% of successfully treated visceral leishmaniasis (VL) patients in Sudan. PKDL is considered an important reservoir for the parasite and its treatment may help in the control of VL. Currently, treatment is mainly with sodium stibogluconate (SSG), an expensive and fairly toxic drug and without universally in treatment protocols used. A literature review, a consensus of a panel of experts, and unpublished data formed the basis for the development of guidelines for the treatment of PKDL in the Sudan. Six treatment modalities were evaluated. Experts were asked to justify their choices based on their experience regarding of drug safety, efficacy, availability, and cost. The consensus was defined by assigning a categorical rank (first line, second line, third line) to each option. Regarding the use of AmBisome the presence of the drug in the skin was confirmed in smears from PKDL lesions.
AmBisome at 2.5 mg/kg/day/20 days or SSG at 20 mg/kg/day/40 days plus four/weekly intradermal injection of alum-precipitated autoclave L. major vaccine are suggested as first- and second-treatment options for PKDL in the Sudan, respectively. SSG at 20 mg/Kg/day/60 or more days can be used if other options are not available.
在苏丹，超过 50%成功治疗内脏利什曼病（VL）的患者会出现卡拉-阿瑟氏后皮肤利什曼病（PKDL），这是一种影响皮肤的疾病。PKDL 被认为是寄生虫的一个重要储存库，其治疗可能有助于控制 VL。目前，治疗主要采用葡萄糖酸锑钠（SSG），这是一种昂贵且毒性相当大的药物，并非在所有治疗方案中都使用。文献回顾、专家组共识和未发表的数据为制定苏丹 PKDL 治疗指南提供了依据。评估了六种治疗方式。专家们被要求根据药物安全性、疗效、可用性和成本方面的经验，对其选择进行解释。通过对每种选择进行分类排名（一线、二线、三线）来确定共识。关于使用两性霉素 B 脂质体，从 PKDL 病变的涂片上证实了该药物在皮肤中的存在。
两性霉素 B 脂质体 2.5mg/kg/天/20 天或葡萄糖酸锑钠 20mg/kg/天/40 天，加每周 4 次皮内注射明矾沉淀的巴氏灭菌利什曼原虫疫苗，分别作为苏丹 PKDL 的一线和二线治疗选择。如果其他选择不可用，可以使用葡萄糖酸锑钠 20mg/kg/天/60 天或更长时间。
