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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Immunochemotherapy of persistent post-kala-azar dermal leishmaniasis: a novel approach to treatment
Transactions of the Royal Society of Tropical Medicine and Hygiene, Volume 102, No. 1, Year 2008
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Description
Post-kala-azar dermal leishmaniasis (PKDL) is a recognized dermatosis that follows successful treatment of visceral leishmaniasis in the Sudan. This randomized and double-blind study aimed to assess safety, immunogenicity and curative potentials of a novel immunochemotherapy regimen in patients with persistent PKDL. Following informed consent, 30 patients were randomized to receive alum-precipitated autoclaved Leishmania major (Alum/ALM) vaccine + Bacille Calmette-Guérin (BCG) and sodium stibogluconate (SSG) or vaccine diluent and SSG. The SSG+Alum/ALM+BCG proved safe with minimal local adverse events. In the SSG+vaccine group, 87% of the patients were cured by day 60 compared with 53% in the SSG alone group (SSG+vaccine efficacy = 71%, 95% CI for risk ratio 0.7-1.16). On day 90 of follow-up there were two relapses in the SSG alone arm and none in the SSG+vaccine arm. Pre-treatment cytokines showed high IFN-γ or high IFN-γ/IL-10 levels and leishmanin skin test (LST) non-reactivity, while healing/clinical improvement were associated with LST reactivity and low IFN-γ levels in both study groups (P = 0.004). In conclusion, SSG+Alum/ALM+BCG is safe and immunogenic with significant healing potentials in persistent PKDL lesions. Immunochemotherapy probably augmented IFN-γ production, which induced healing. Leishmanin skin reactivity is a good surrogate marker of cure in persistent PKDL lesions. © 2007 Royal Society of Tropical Medicine and Hygiene.
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, Khartoum
National Ribat University
Elgawi, Sara Hamad Hassab
Sudan, Khartoum
Institute of Endemic Diseases Sudan
Modabber, Farrokh Z.
Sudan, Khartoum
Institute of Endemic Diseases Sudan
Elkadaru, Abd Elgadir Mohamed Yousif
Sudan
Tropical Diseases Hospital
Aboud, Mona
Sudan
Tropical Diseases Hospital
Noazin, Sassan
Switzerland, Geneva
Organisation Mondiale de la Santé
Ghalib, Hashim Warsama
Switzerland, Geneva
Organisation Mondiale de la Santé
el-Hassan, Ahmed Mohamed A.
Sudan, Khartoum
Institute of Endemic Diseases Sudan
Statistics
Citations: 98
Authors: 10
Affiliations: 4
Identifiers
Doi:
10.1016/j.trstmh.2007.08.006
ISSN:
00359203
Research Areas
Disability
Health System And Policy
Study Design
Cohort Study
Study Locations
Sudan