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Assessing the Efficacy and Safety of Liposomal Amphotericin B and Miltefosine in Combination for Treatment of Post Kala-Azar Dermal Leishmaniasis.
The Journal of Infectious Diseases ( IF 6.4 ) Pub Date : 2019-12-19 , DOI: 10.1093/infdis/jiz486
V Ramesh 1 , Keerti Kaumudee Dixit 2, 3 , Neha Sharma 1 , Ruchi Singh 2 , Poonam Salotra 2
Affiliation  

BACKGROUND No satisfactory canonical treatment is available for post-kala-azar dermal leishmaniasis (PKDL), clinical sequela of visceral leishmaniasis. Confined treatment options and substantial increase in relapse rate after miltefosine (MIL) treatment warrant the need to adapt resilient combination therapies. In this study, we assessed the safety and efficacy of combination therapy using liposomal amphotericin B (LAmB) and MIL for treating PKDL. METHODS Thirty-two PKDL patients, confirmed by microscopy or quantitative polymerase chain reaction (qPCR), were included in the study. An equal number of cases (n = 16) were put on MIL monotherapy (100 mg/day for 90 days) or MIL and LAmB combination for 45 days (3 injections of LAmB, 5 mg/kg body weight, and 100 mg/day MIL). Parasite load in slit aspirate was monitored using qPCR. RESULTS Patients treated with combination therapy demonstrated a rapid decline in parasite load and achieved 100% cure, with no reports of relapse. Those treated with MIL monotherapy attained clinical cure with a gradual decrease in parasite load; however, 25% relapsed within 18 months of follow-up. CONCLUSIONS Liposomal amphotericin B and MIL combination for treating PKDL is efficacious and safe, with high tolerability. Furthermore, this study established the utility of minimally invasive slit aspirate method for monitoring of parasite load and assessment of cure in PKDL.

中文翻译:

评估脂质体两性霉素B和米替福星联合治疗后Kala-Azar皮肤利什曼病的疗效和安全性。

背景技术对于黑热病后皮肤利什曼病(PKDL),内脏利什曼病的临床后遗症,尚无令人满意的规范治疗方法。米替福辛(MIL)治疗后,有限的治疗选择和复发率的大幅提高保证了需要采用有弹性的联合疗法。在这项研究中,我们评估了使用脂质体两性霉素B(LAmB)和MIL联合治疗PKDL的安全性和有效性。方法本研究纳入了32例经显微镜检查或定量聚合酶链反应(qPCR)确诊的PKDL患者。进行相同数量的病例(n = 16)进行MIL单药治疗(100 mg /天,共90天)或进行MIL和LAmB组合治疗45天(3次LAmB注射,5 mg / kg体重和100 mg /天的注射) MIL)。使用qPCR监测狭缝抽吸物中的寄生虫负荷。结果联合治疗的患者表现出寄生虫负荷快速下降,治愈率100%,无复发报告。接受MIL单一疗法治疗的患者可通过逐渐减少寄生虫负荷获得临床治愈;但是,有25%的患者在随访18个月内复发。结论脂质体两性霉素B和MIL联合治疗PKDL有效,安全,耐受性高。此外,本研究建立了微创缝隙抽吸法在监测PKDL中的寄生虫负荷和评估治愈率方面的实用性。随访18个月内25%复发。结论脂质体两性霉素B和MIL联合治疗PKDL有效,安全,耐受性高。此外,本研究建立了微创缝隙抽吸法在监测PKDL中的寄生虫负荷和评估治愈率方面的实用性。随访18个月内25%复发。结论脂质体两性霉素B和MIL联合治疗PKDL有效,安全,耐受性高。此外,本研究建立了微创缝隙抽吸法在监测PKDL中的寄生虫负荷和评估治愈率方面的实用性。
更新日期:2020-02-04
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