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治疗黑热病后皮肤利什曼病后的角膜并发症。

Corneal complications following Post Kala-azar Dermal Leishmaniasis treatment.

机构信息

Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh.

出版信息

PLoS Negl Trop Dis. 2018 Sep 17;12(9):e0006781. doi: 10.1371/journal.pntd.0006781. eCollection 2018 Sep.


DOI:10.1371/journal.pntd.0006781
PMID:30222747
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6160237/
Abstract

Post Kala-azar Dermal Leishmaniasis (PKDL) is a sequel of Visceral Leishmaniasis (VL). The patients act as a reservoir for the causative parasite (i.e. Leishmania donovani) and thus should be diagnosed and treated with the utmost urgency to prevent the transmission of the disease. In this study, we tried to report the first instances of corneal complications supposedly associated with Miltefosine (MF), in PKDL patients and the probable pathophysiology of such events. The recently rejuvenated National Kala-azar Elimination Program in Bangladesh has put great emphasis on monitoring all the leishmaniasis patients to investigate possible adverse drug reactions (ADR). A total of 194 patients have received Miltefosine for the treatment of Post Kala-azar Dermal Leishmaniasis. So far five patients were found to have developed unilateral ophthalmic complications during the periods from May 2016 to October 2017, after being treated with MF for PKDL. Unfortunately, one of whom had to go through complete evisceration of the affected eyeball. Despite the fact that MF is the only oral formulation of choice to treat PKDL, occurrences of such unexpected ADRs after MF administration urges the exploration of the pathogenesis of such incidents and determine measures to avert such occurrences from happening in future.

摘要

皮肤利什曼病后(PKDL)是内脏利什曼病(VL)的一种后遗症。患者成为病原体(即利什曼原虫)的储存库,因此应尽快诊断和治疗,以防止疾病传播。在这项研究中,我们试图报告与米替福新(MF)相关的角膜并发症的首例病例,以及此类事件的可能病理生理学。孟加拉国最近复兴的国家黑热病消除计划非常重视监测所有利什曼病患者,以调查可能的药物不良反应(ADR)。共有 194 名患者接受米替福新治疗皮肤利什曼病后皮肤利什曼病。迄今为止,自 2016 年 5 月至 2017 年 10 月,已有 5 名患者在接受 MF 治疗 PKDL 后出现单侧眼部并发症。不幸的是,其中一名患者不得不接受受影响眼球的完全剜除。尽管 MF 是治疗 PKDL 的唯一口服选择药物,但 MF 给药后出现这种意外的 ADR 事件促使人们探索这种事件的发病机制,并确定措施,以避免将来再次发生这种事件。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3fb7/6160237/d17a222de087/pntd.0006781.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3fb7/6160237/d17a222de087/pntd.0006781.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3fb7/6160237/d17a222de087/pntd.0006781.g001.jpg

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本文引用的文献

[1]
Challenges for management of post kala-azar dermal leishmaniasis and future directions.

Res Rep Trop Med. 2014-11-14

[2]
Keratitis After Post-Kala-Azar Dermal Leishmaniasis.

Cornea. 2018-1

[3]
Infectivity of Post-Kala-azar Dermal Leishmaniasis Patients to Sand Flies: Revisiting a Proof of Concept in the Context of the Kala-azar Elimination Program in the Indian Subcontinent.

Clin Infect Dis. 2017-7-1

[4]
Drug-induced corneal epithelial changes.

Surv Ophthalmol. 2017

[5]
Post-Kala-Azar Dermal Leishmaniasis Without Previous History of Visceral Leishmaniasis.

Am J Trop Med Hyg. 2016-12-7

[6]
Retinal changes in visceral leishmaniasis by retinal photography.

BMC Infect Dis. 2014-9-30

[7]
Drug induced phospholipidosis: an acquired lysosomal storage disorder.

Biochim Biophys Acta. 2013-3

[8]
Miltefosine: a review of its pharmacology and therapeutic efficacy in the treatment of leishmaniasis.

J Antimicrob Chemother. 2012-7-24

[9]
Blindness following visceral leishmaniasis: a neglected post-kala-azar complication.

Trop Doct. 2011-7

[10]
Detection of Leishmania spp. and associated inflammation in ocular-associated smooth and striated muscles in dogs with patent leishmaniosis.

Vet Ophthalmol. 2010-5

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