Antimony to Cure Visceral Leishmaniasis Unresponsive to Liposomal Amphotericin B

Abstract

We report on 4 patients (1 immunocompetent, 3 immunosuppressed) in whom visceral leishmaniasis had become unresponsive to (or had relapsed after) treatment with appropriate doses of liposomal amphotericin B. Under close follow-up, full courses of pentavalent antimony were administered without life-threatening adverse events and resulted in rapid and sustained clinical and parasitological cure.

Fig 1. “black rectangle” VL episode; “hatched rectangle” oligosymptomatic VL; BM: bone marrow; PB: peripheral blood; LN: lymph node; BAL: broncho-alveolar lavage; q.3.w: every 3 weeks; mo: month; quantitative PCR (N = negative; 1+ = 0.5–10; 2+ = 11–100; 3+ = 101–1000; 4+ = 1001–100000; 5+ >100000 parasites/ml).

(A)Treatment advice for VL: All patients received L-AmB as first-line treatment[2]; 4 became unresponsive to L-AmB as defined by failure or relapse with positive PCR for Leishmania after at least 2 complete courses (20–60 mg/kg cumulated dose/course). (B) Follow-up of 4 patients non-responders to L-AmB: Cure was defined as a negative smear, culture or PCR on leukoconcentrated blood plus remission of clinical signs and symptoms of VL with no relapse during 6 months. Relapse was defined as positive Leishmania PCR (any sample) associated with recurrence of ≥3 of the following markers: fever, splenomegaly, hepatomegaly, anemia, leukopenia, thrombocytopenia, weight loss, asthenia, digestive or cutaneous symptoms suggestive of VL. Patient information and consent were as per FNRCL procedures (http://www.parasitologie.univ-montp1.fr/conseil.htm). Doses of meglumine antimoniate (Glucantime) are expressed in mg of pentavalent antimony/kg.