Piarroux R, Garnier J M, Gambarelli F, Dumon H, Kaplanski S, Unal D
Service de pédiatrie, hôpital de La Timone, Marseille, France.
Arch Pediatr. 1996 Apr;3(4):352-6. doi: 10.1016/0929-693x(96)84691-4.
Resistance to antimonial drugs is rarely observed in immunocompetent patients.
A 1-year-old girl was admitted suffering from persistent fever. A diagnosis of visceral leishmaniasis was made. The patient was given two courses of meglumine antimoniate (Glucantime) (60 mg/kg/d for 15 days) and one course of 12 injections of pentamidine (4 mg/kg). She relapsed 8 months later and failed to respond to Glucantime. Immunological tests performed during the relapse showed a suppression of the T cell response to Leishmania antigen and no production of interferon gamma. The patient was then successfully given liposomal amphotericin B (3 mg/kg/d for 10 days). She was asymptomatic 9 months later and had acquired specific cellular immunity against Leishmania.
Deficient cell-mediated immunity and interferon gamma production are some factors responsible for decreased sensitivity to antimonial drugs. The WHO recommendations treating visceral leishmaniasis with prolonged administration of Glucantime may prevent relapses. Liposomal amphotericin B could be an alternative treatment.
在免疫功能正常的患者中很少观察到对锑剂的耐药性。
一名1岁女孩因持续发热入院。诊断为内脏利什曼病。该患者接受了两个疗程的葡甲胺锑酸盐（葡糖胺锑，60毫克/千克/天，共15天）治疗以及一个疗程的12次喷他脒注射（4毫克/千克）。8个月后她复发，对葡糖胺锑无反应。复发期间进行的免疫测试显示T细胞对利什曼原虫抗原的反应受到抑制，且未产生γ干扰素。随后该患者成功接受了脂质体两性霉素B治疗（3毫克/千克/天，共10天）。9个月后她无症状，且已获得针对利什曼原虫的特异性细胞免疫。
细胞介导免疫缺陷和γ干扰素产生是导致对锑剂敏感性降低的一些因素。世界卫生组织关于长期使用葡糖胺锑治疗内脏利什曼病的建议可能会预防复发。脂质体两性霉素B可能是一种替代治疗方法。
