antimony-sodium-gluconate and Anemia

Among patients with primary and relapse visceral leishmaniasis (VL) in eastern Sudan, we determined the proportion eligible for treatment with sodium stibogluconate and paromomycin (SSG/PM) and, of these, their demographic and clinical characteristics; initial treatment outcomes including adverse side effects requiring treatment discontinuation; treatment outcomes by 6 months; and risk factors associated with initial (slow responders) and late treatment failure (relapses and post-kala-azar dermal leishmaniasis, PKDL).. A retrospective cohort study in Tabarak Allah Hospital, Gedaref Province, eastern Sudan, from July 2011 to January 2014.. Of 1252 individuals diagnosed with VL (1151 primary and 101 relapses), 65% were eligible for SSG/PM including 83% children, almost half of them malnourished and anaemic. About 4% of individuals discontinued treatment due to side effects; 0.7% died during treatment. Initial cure was achieved in 93% of 774 primary cases and 77% of 35 relapse cases (P < 0.001). Among the 809 patients eligible for SSG/PM, 218 (27%) were lost to follow-up. Outcomes by six months among the 591 patients with available follow-up data were: definitive cure (n = 506; 86%), relapse (n = 38; 6%), treatment discontinuation (n = 33; 6%), PKDL (n = 7; 1%) and death (n = 7; 1%). Among those completing a full course of SSG/PM, relapses and under-fives were at significantly higher risk of early and late treatment failure, respectively.. Whether SSG/PM as a first-line regimen is an undeniable progress compared to SSG monotherapy, it excluded a considerable proportion of VL patients due to drug safety concerns. We call for accelerated development of new drugs and treatment regimens to improve VL treatment in Sudan.

Topics: Adolescent; Adult; Anemia; Antimony Sodium Gluconate; Antiprotozoal Agents; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Leishmaniasis, Visceral; Lost to Follow-Up; Male; Malnutrition; Paromomycin; Patient Selection; Prevalence; Recurrence; Retrospective Studies; Sudan; Treatment Failure

Topics: Anemia; Animals; Antimony Sodium Gluconate; Antiprotozoal Agents; Dermatitis; Diagnosis, Differential; Dog Diseases; Dogs; Fatal Outcome; Finland; Histocytochemistry; Leishmania infantum; Leishmaniasis; Macrophages; Male; Microscopy, Electron; Spain; Tongue; Tongue Neoplasms

We have studied the mechanism of a transfusion-dependent anaemia found in a two-year-old Maltese girl with visceral leishmaniasis that was resistant to multiple courses of antimonial therapy. Major factors contributing to the anaemia were haemolysis occurring in both the massively enlarged spleen and liver and haemodilution resulting from expansion of the plasma volume. There was no evidence of significant ineffective erythropoiesis, but a reduced plasma iron in the presence of greatly increased iron stores suggested that reticuloendothelial hyperplasia was accompanied by abnormal iron retention by macrophages typical of the 'anaemia of chronic disorders'. This may limit the erythropoietic response to anaemia in chronic visceral leishmaniasis.

Topics: Anemia; Antimony Sodium Gluconate; Erythrocyte Aging; Erythropoiesis; Female; Ferritins; Humans; Infant; Iron; Iron Radioisotopes; Leishmaniasis, Visceral; Pentamidine

Topics: Adult; Anemia; Antimony Sodium Gluconate; Diagnosis, Differential; Fever of Unknown Origin; Hepatomegaly; Humans; Leishmaniasis, Visceral; Leukopenia; Male; Splenomegaly