Datta Adrija, Podder Indrashis, Das Anupam, Sil Amrita, Das Nilay Kanti
Department of Dermatology, Institute of Post Graduate Medical Education and Research, Kamarhati, West Bengal, India.
Department of Dermatology, Venereology and Leprosy, College of Medicine and Sagore Dutta Hospital, Kamarhati, West Bengal, India.
Indian J Dermatol. 2021 Jan-Feb;66(1):34-43. doi: 10.4103/ijd.IJD_264_20.
Post-kala-azar dermal Leishmaniasis (PKDL) is one of the important neglected tropical diseases, which has a tremendous epidemiological significance, being the reservoir of kala-azar. Relapse and resistance to treatment along with the lack of a drug of choice and consensus treatment guideline pose a significant problem in the management of PKDL. The aim of this article was to review the available therapeutic options for PKDL, with special emphasis on their pharmaco-dynamics, pharmaco-kinetics, effectiveness, safety, tolerability, and cost factor. A comprehensive English language literature search was done for therapeutic options in PKDL across multiple databases (PubMed, EMBASE, MEDLINE, and Cochrane) for keywords (alone and in combination). MeSH as well as non-MeSH terms such as "Kala-azar," "Leishmaniasis" AND "Treatment," "Management," "Antimony Sodium Gluconate," "Meglumine Antimoniate," "Amphotericin B," "Paromomycin," "Miltefosine" were taken into consideration. Among 576 relevant articles, 15 were deemed relevant to this review. These articles were evaluated using "Oxford Centre for Evidence-Based Medicine (OCEBM)" AND "strength of recommendation taxonomy" (SORT) with respect to the level of evidence and grade of recommendation. The review includes 15 studies. The use of sodium stibogluconate is being discouraged because of multiple documented reports of treatment failure. Liposomal amphotericin B is emerging as a favorable option, owing to its superiority in terms of effectiveness and safety profile. Miltesfosine is the drug of choice in India because of the ease of oral administration and minimal risk of toxicity. Isolated Paromomycin alone is not effective in PKDL; however, combination therapy with sodium stibogluconate is found to be safe and effective. Combination of amphotericin B and miltefosine is one of the excellent options. Immunotherapy with combination of alum-precipitated autoclaved Leishmania major (Alum/ALM) vaccine + Bacille Calmette-Gu´erin (BCG) has shown promising results. Kala-azar continues to haunt the tropical countries and PKDL being its reservoir is threatening its elimination. With the availability of drugs such as liposomal amphotericin B and miltefosine, apart from the advent of immunotherapy, the future of treatment of this condition looks promising.
黑热病后皮肤利什曼病（PKDL）是一种重要的被忽视的热带病，具有巨大的流行病学意义，是黑热病的储存宿主。复发、治疗耐药性以及缺乏首选药物和共识性治疗指南给PKDL的管理带来了重大问题。本文旨在综述PKDL可用的治疗选择，特别强调其药效学、药代动力学、有效性、安全性、耐受性和成本因素。通过在多个数据库（PubMed、EMBASE、MEDLINE和Cochrane）中使用关键词（单独和组合）对PKDL的治疗选择进行了全面的英文文献检索。考虑了医学主题词（MeSH）以及非MeSH术语，如“黑热病”、“利什曼病”以及“治疗”、“管理”、“葡萄糖酸锑钠”、“葡甲胺锑酸盐”、“两性霉素B”、“巴龙霉素”、“米替福新”。在576篇相关文章中，15篇被认为与本综述相关。使用“牛津循证医学中心（OCEBM）”和“推荐强度分类法”（SORT）对这些文章的证据水平和推荐等级进行了评估。该综述包括15项研究。由于有多项关于治疗失败的记录报告，不鼓励使用葡萄糖酸锑钠。脂质体两性霉素B因其在有效性和安全性方面的优势而成为一个有利的选择。米替福新在印度是首选药物，因为其口服方便且毒性风险最小。单独使用巴龙霉素对PKDL无效；然而，与葡萄糖酸锑钠联合治疗被发现是安全有效的。两性霉素B和米替福新联合是极佳的选择之一。用明矾沉淀的高压灭菌的硕大利什曼原虫（Alum/ALM）疫苗+卡介苗（BCG）联合进行免疫治疗已显示出有希望的结果。黑热病继续困扰着热带国家，而PKDL作为其储存宿主正威胁着黑热病的消除。随着脂质体两性霉素B和米替福新等药物的出现，除了免疫治疗的出现，这种疾病治疗的未来看起来很有希望。
