antimony-sodium-gluconate and Parasitemia

Visceral leishmaniasis (VL) is endemic in many countries worldwide, including India. Globally, sodium stibogluconate (Sb) remains the cornerstone of therapy, except in some parts of India owing to increasing drug resistance. Although electrocardiographic changes associated with Sb therapy have been described, global cardiac function using tools such as colour Doppler echocardiography is less well studied. We evaluated the cardiac function of 14 newly diagnosed VL patients using two-dimensional M-mode and Doppler echocardiography. The evaluations were performed before, during and at the end of Sb therapy. Left ventricular function and dimensions remained within normal limits in all patients. Pericardial effusion was noted in four patients with heavy parasitaemia. Effusions were small, haemodynamically insignificant and resolved spontaneously. We conclude that pericardial effusion may occur in VL patients with heavy parasitaemia.

Topics: Adolescent; Adult; Aged; Antimony Sodium Gluconate; Antiprotozoal Agents; Child; Child, Preschool; Echocardiography, Doppler, Color; Female; Humans; Leishmaniasis, Visceral; Male; Middle Aged; Parasitemia; Pericardial Effusion; Ventricular Function, Left

Kala-azar in India is becoming increasingly difficult to treat, which may be due to the presence of species other than Leishmania donovani; Leishmania tropica was reported to cause the same clinical syndrome in the area. Over the past 3 years, we have collected samples from 241 patients with visceral leishmaniasis from across the region. Of the 189 isolates that grew on diphasic medium, 159 were successfully transferred to liquid medium for typing. Clinically, 80% of these were resistant to antimony. Lipophosphoglycan-specific monoclonal antibodies were used to distinguish the 2 species by agglutination of promastigotes; all 159 were shown to be L. donovani. Eighty-three isolates were confirmed to be L. donovani by isoenzyme analysis, by amplification of kinetoplast DNA, or both, in comparison with multiple reference strains; none were L. tropica. Thus, the rising incidence of clinical resistance to treatment is unlikely to be due to a different species causing kala-azar in north Bihar.

Topics: Adolescent; Adult; Animals; Antibodies, Protozoan; Antimony Sodium Gluconate; Antiprotozoal Agents; Child; DNA, Kinetoplast; DNA, Protozoan; Drug Resistance; Electrophoresis, Cellulose Acetate; Female; Humans; India; Leishmania donovani; Leishmania tropica; Leishmaniasis, Visceral; Male; Middle Aged; Parasitemia