Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Kala-Azar Medical Research Center, Muzaffarpur, India.
Am J Trop Med Hyg. 2024 Jun 4;111(1):59-63. doi: 10.4269/ajtmh.23-0738. Print 2024 Jul 3.
Post-kala-azar dermal leishmaniasis (PKDL) is widely prevalent in the endemic regions of India, but its treatment remains unsatisfactory. The WHO recommends a 12-week treatment with oral miltefosine, but its ocular toxicities are a serious concern. The late 1980s and early 1990s saw the use of sodium stibogluconate and amphotericin B (AmB) for a brief period. Both drugs had frequent adverse events and were expensive, and the duration of treatments was unacceptably long. This retrospective study evaluated, analyzed, and reported the outcomes of PKDL patients treated with a shorter course of AmB, the most effective antileishmanial drug. The hospital records of PKDL patients treated with AmB by 30 alternate-day infusions over 60 days (instead of conventional 60-80 infusions over 100-120 days) between September 2010 and August 2016 were reviewed. Only patients with confirmed parasitological diagnosis were included. Their records were studied for treatment-related adverse events, end-of-treatment parasitological status, and 12-month follow-up results. One hundred two patients were eligible for this study between September 2010 and August 2016. After therapy, 92/102 (90.2%) patients improved; 3 (2.9%) had to cease treatment owing to severe adverse effects, and one died of severe diarrhea unrelated to AmB. Six (5.9%) patients withdrew consent before the treatment was complete. At the 12-month evaluation, 89/102 (87.3%) patients attained a final cure. A 30-infusion regimen of AmB remains highly effective in PKDL. Without a shorter, safer, and more economical regimen for the treatment of PKDL, it should be used until a better regimen is available.
内脏利什曼病后皮肤利什曼病（PKDL）在印度流行地区广泛存在，但治疗效果仍不理想。世界卫生组织（WHO）建议采用口服米替福新治疗 12 周，但该药的眼部毒性令人严重关切。20 世纪 80 年代末和 90 年代初，曾短暂使用过葡萄糖酸锑钠和两性霉素 B（AmB）。这两种药物都有频繁的不良反应，且价格昂贵，治疗时间也长到无法接受。本回顾性研究评估、分析并报告了采用更短疗程两性霉素 B 治疗 PKDL 患者的结果，两性霉素 B 是最有效的抗利什曼原虫药物。本研究回顾性分析了 2010 年 9 月至 2016 年 8 月期间，102 例 PKDL 患者接受 30 个间隔日输注两性霉素 B（60 天），而非传统的 100-120 天内 60-80 个输注（120 天）治疗的记录。仅纳入经寄生虫学确诊的患者。研究了与治疗相关的不良反应、治疗结束时寄生虫状态和 12 个月随访结果。2010 年 9 月至 2016 年 8 月期间，共有 102 例患者符合本研究条件。治疗后，92/102（90.2%）例患者病情改善；3（2.9%）例患者因严重不良反应而停药，1 例患者因与两性霉素 B 无关的严重腹泻死亡。6（5.9%）例患者在治疗完成前退出。在 12 个月评估时，89/102（87.3%）例患者获得最终治愈。30 次输注两性霉素 B 方案治疗 PKDL 仍然非常有效。在有更短、更安全、更经济的 PKDL 治疗方案之前，应继续使用该方案。
