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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Efficacy of liposomal amphotericin B (AmBisome®) in the treatment of persistent post-kala-azar dermal leishmaniasis (PKDL)
Annals of Tropical Medicine and Parasitology, Volume 99, No. 6, Year 2005
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Description
A dermatosis commonly known as post-kala-azar dermal leishmaniasis (PKDL) may develop following the treatment of human visceral leishmaniasis (VL). In about 15% of PKDL cases the disfiguring lesions persist, sometimes for many years. Such persistent lesions currently require daily injections of sodium stibogluconate (SSG) for 2-4 months and even then treatment may not be successful. Alternative, quicker and cheaper treatment options that cause less toxicity are being explored. Immuno-chemotherapeutic regimens (based on leishmaniasis candidate vaccines/BCG with SSG) are still experimental but treatment with liposomal amphotericin B (AmBisome®) has already been found effective, albeit in a small number of patients. AmBisome is considered less nephrotoxic than non-liposomal amphotericin B because it specifically targets the macrophages in which the Leishmania parasites develop. The aim of the present study was to evaluate further the usefulness of AmBisome in the treatment of persistent PKDL, in Sudan. The 12 subjects, all of whom gave their informed consent, had each had PKDL lesions for >6 months and shown no improvement after repeated injections of SSG. During the study period, they were hospitalized and regularly screened, haematologically and biochemically, for adverse effects. The AmBisome, given intravenously at 2.5 mg/kg.day for 20 days, completely cleared the skin rash of 10 (83%) of the patients and caused no detectable adverse effects. In the 10 patients who responded well to the treatment, the papular lesions regressed and became flat while the hypopigmented lesions darkened (continuing to do so even after the last AmBisome injections). Treatment outcome appeared to be unaffected by the age or gender of the patient (P=0.7 for each) but the time taken for the PKDL lesions to heal was correlated with the age of the lesions (P=0.009). The macular lesions healed more slowly than the papular (P=0.02). In conclusion, Ambisome appears suitable for the treatment of persistent PKDL lesions in Sudan. Once certain favourable clinical signs (the regression and/or darkening of the PKDL lesions) have been noted, the lesions will probably continue to clear without the need for more injections. © 2005 The Liverpool School of Tropical Medicine.
Authors & Co-Authors
Musa, Ahmed Mudawi
Sudan, Khartoum
Institute of Endemic Diseases Sudan
Khalil, Eltahir Awad Gasim
Sudan, Khartoum
Institute of Endemic Diseases Sudan
Mahgoub, Fawzi Abd Elrahim
Sudan
El Ribat Elwatani University
Hamad, S. H.
Sudan, Khartoum
Institute of Endemic Diseases Sudan
Elkadaru, Abd Elgadir Mohamed Yousif
Sudan, Khartoum
University of Khartoum Faculty of Medicine
el-Hassan, Ahmed Mohamed A.
Sudan, Khartoum
Institute of Endemic Diseases Sudan
Statistics
Citations: 53
Authors: 6
Affiliations: 3
Identifiers
Doi:
10.1179/136485905X514127
ISSN:
00034983
Research Areas
Health System And Policy
Study Locations
Sudan