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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Liposomal amphotericin B for complicated visceral leishmaniasis (kala-azar) in eastern Sudan: How effective is treatment for this neglected disease?
Tropical Medicine and International Health, Volume 19, No. 2, Year 2014
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Description
Objectives: The aim of this study was to report the patient profile and treatment outcomes, including relapses, of patients with visceral leishmaniasis (VL) treated with liposomal amphotericin B (AmBisome) in Gedaref, Sudan. Methods: AmBisome was offered to two groups of patients: primary VL patients with specific criteria (age ≤2 or ≥45 years, advanced clinical disease, pregnancy, HIV co-infection and contraindications for antimonials) and VL relapses. AmBisome was given at a total dose of 30 mg/kg, over 10 days. Slow responders received up to 50 mg/kg. Treatment failure was confirmed parasitologically. Standardised treatment outcomes were assessed. Results: Between March 2010 and June 2012, a total of 281 (74%) patients with primary VL and 98 (26%) patients with VL relapses received AmBisome (54% male, median age = 11 years, interquartile range 2-30). End-of-treatment outcomes for primary VL were 260 (92%) initial cure including three (1%) slow responders, three (1%) treatment failures, 14 (5%) deaths and four (1%) unknown outcomes. Outcomes for VL relapses were 92 (94%) initial cure with five (5%) slow responders, four (4%) treatment failures, one (1%) death and one (1%) unknown outcome. At 6 months, there were 19 (7%) relapses amongst primary VL and 10 (10%) VL relapses had a new relapse. Loss to follow-up in both groups was 38%. None of the deaths that occurred during the study period was attributed to AmBisome. Conclusion: AmBisome appears to be effective for initial cure of VL and the drug seems safe, but is expensive (400 USD/treatment). Sustained mechanisms to allow improved access of this expensive drug particularly in East Africa are urgently needed. Relapses and losses to follow-up require specific investigation. © 2014 John Wiley & Sons Ltd.
Authors & Co-Authors
Salih, Niven A.Wahab
Switzerland, Geneva
Medecins Sans Frontieres
van Griensven, Johan
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Chappuis, François P.
Switzerland, Geneva
Medecins Sans Frontieres
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Antierens, Annick
Switzerland, Geneva
Medecins Sans Frontieres
Mumina, Ann
Switzerland, Geneva
Medecins Sans Frontieres
Hammam, Omer
Switzerland, Geneva
Medecins Sans Frontieres
Boulle, Philippa
Switzerland, Geneva
Medecins Sans Frontieres
Alirol, Emilie
Switzerland, Geneva
Medecins Sans Frontieres
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Alnour, Mubarak
Sudan, Dongola
Ministry of Health
Elhag, Mousab Siddig
Sudan, Khartoum
Federal Ministry of Health Sudan
Manzi, Marcel
Switzerland, Geneva
Medecins Sans Frontieres
Kizito, Walter
Switzerland, Geneva
Medecins Sans Frontieres
Zachariah, Rony R.Z.
Switzerland, Geneva
Medecins Sans Frontieres
Statistics
Citations: 41
Authors: 13
Affiliations: 5
Identifiers
Doi:
10.1111/tmi.12238
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Study Locations
Multi-countries
Sudan
Participants Gender
Male