1
|
Sreedharan V, Rao KB. Protease inhibitors as a potential agent against visceral Leishmaniasis: A review to inspire future study. Braz J Infect Dis 2023; 27:102739. [PMID: 36603827 PMCID: PMC9871078 DOI: 10.1016/j.bjid.2022.102739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/21/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023] Open
Abstract
Leishmaniasis is transmitted by sandfly which carries the intracellular protozoa in their midgut. Among visceral, cutaneous and mucocutaneous leishmaniasis, visceral type that is caused by Leishmania donovani is the most lethal one. Findings of leishmanial structure and species took place in 19th century and was initiated by Donovan. Leishmaniasis is still a major concern of health issues in many endemic countries in Asia, Africa, the Americas, and the Mediterranean region. Worldwide1.5-2 million new cases of cutaneous leishmaniasis and 500,000 cases of visceral leishmaniasis are reported each year. Leishmaniasis is endemic in nearly 90 countries worldwide and close to 12 million new cases of leishmaniasis are reported worldwide annually. Studies on antileishmanial drug development is of major concern as leishmaniasis are the second largest parasitic killer in the world and the available drugs are either toxic or costly. The major surface GP63 protease, also known as Zinc- metalloproteases present on the surface of leishmanial promastigotes, can be targeted for drug development. Protease inhibitors targeting such surface proteases show promising results. Different protease inhibitors have been isolated from marine actinobacteria against many infectious diseases. Metabolites produced by these actinobacteria may have greater importance for the discovery and development of new antileishmanial drugs. Hence, this review discusses the background, current situation, treatment, and protease inhibitors from marine actinobacteria for drug development against GP63 molecules.
Collapse
Affiliation(s)
| | - K.V. Bhaskara Rao
- Corresponding author at: Department of Biomedical Sciences, School of BioSciences and Technology, VIT University, Vellore, Tamil Nadu, 632 014, India.
| |
Collapse
|
2
|
Zamir M, Nadeem F, Alqudah MA, Abdeljawad T. Future implications of COVID-19 through Mathematical modeling. RESULTS IN PHYSICS 2022; 33:105097. [PMID: 34976710 PMCID: PMC8709924 DOI: 10.1016/j.rinp.2021.105097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 05/30/2023]
Abstract
COVID-19 is a pandemic respiratory illness. The disease spreads from human to human and is caused by a novel coronavirus SARS-CoV-2. In this study, we formulate a mathematical model of COVID-19 and discuss the disease free state and endemic equilibrium of the model. Based on the sensitivity indexes of the parameters, control strategies are designed. The strategies reduce the densities of the infected classes but do not satisfy the criteria/threshold condition of the global stability of disease free equilibrium. On the other hand, the endemic equilibrium of the disease is globally asymptotically stable. Therefore it is concluded that the disease cannot be eradicated with present resources and the human population needs to learn how to live with corona. For validation of the results, numerical simulations are obtained using fourth order Runge-Kutta method.
Collapse
Affiliation(s)
- Muhammad Zamir
- Department of Mathematics, University of Science and Technology, Bannu, Khyber Pakhtunkhwa, Pakistan
| | - Fawad Nadeem
- Department of Mathematics, University of Science and Technology, Bannu, Khyber Pakhtunkhwa, Pakistan
| | - Manar A Alqudah
- Department Mathematical Sciences, Faculty of Sciences, Princess Nourah Bint, Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Thabet Abdeljawad
- Department of Mathematics and Sciences, Prince Sultan University, Riyadh, Saudi Arabia
- Department of Medical Research, China Medical University, Taichung 40402, Taiwan
| |
Collapse
|
3
|
Monge-Maillo B, López-Vélez R. Anfotericina B liposomal en el tratamiento de la leishmaniasis visceral. Rev Iberoam Micol 2021; 38:101-104. [PMID: 34127386 DOI: 10.1016/j.riam.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/04/2021] [Accepted: 04/06/2021] [Indexed: 11/15/2022] Open
Abstract
A review on the current evidence of the efficacy and security of liposomal amphotericinB (L-AmB) for the treatment of visceral leishmaniasis (VL) has been performed. In the Indian subcontinent, a single dose of 10mg/kg has shown effectiveness in the treatment of VL due to Leishmania donovani. In contrast, higher doses of L-AmB (up to 30mg/kg) are required in Africa to treat a VL of the same etiology. When treating VL by Leishmania infantum acquired in the Americas and Europe the usual dose of L-AmB is 20-21mg/kg. In HIV co-infected patients the required doses are usually higher, up to 60mg/kg, and if it is administered in a prophylactic schedule after the treatment of VL relapses are reduced. L-AmB has shown synergism with other antiparasitic drugs, especially with paromomycin in the Indian subcontinent and with miltefosin in patients coinfected with HIV in East Africa. Due to its efficacy and safety profile, L-AmB is the first therapeutic option for VL.
Collapse
Affiliation(s)
- Begoña Monge-Maillo
- Unidad de Referencia Nacional para Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Rogelio López-Vélez
- Unidad de Referencia Nacional para Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España.
| |
Collapse
|
4
|
In Vitro Susceptibility to Miltefosine of Leishmania infantum (syn. L. chagasi) Isolates from Different Geographical Areas in Brazil. Microorganisms 2021; 9:microorganisms9061228. [PMID: 34198947 PMCID: PMC8228039 DOI: 10.3390/microorganisms9061228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/22/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
Treatment of visceral leishmaniasis in Brazil still relies on meglumine antimoniate, with less than ideal efficacy and safety, making new therapeutic tools an urgent need. The oral drug miltefosine was assayed in a phase II clinical trial in Brazil with cure rates lower than previously demonstrated in India. The present study investigated the susceptibility to miltefosine in 73 Brazilian strains of Leishmania infantum from different geographic regions, using intracellular amastigote and promastigote assays. The EC50 for miltefosine of 13 of these strains evaluated in intracellular amastigotes varied between 1.41 and 4.57 μM. The EC50 of the 73 strains determined in promastigotes varied between 5.89 and 23.7 μM. No correlation between in vitro miltefosine susceptibility and the presence of the miltefosine sensitive locus was detected among the tested strains. The relatively low heterogeneity in miltefosine susceptibility observed for the 73 strains tested in this study suggests the absence of decreased susceptibility to miltefosine in Brazilian L. infantum and does not exclude future clinical evaluation of miltefosine for VL treatment in Brazil.
Collapse
|
5
|
Adekiya TA, Kumar P, Kondiah PPD, Pillay V, Choonara YE. Synthesis and therapeutic delivery approaches for praziquantel: a patent review (2010-present). Expert Opin Ther Pat 2021; 31:851-865. [PMID: 33832392 DOI: 10.1080/13543776.2021.1915292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION : Among all the anti-schistosomal drugs, praziquantel has been the most widely used. However, some major challenges have been faced using the drug in the treatment of schistosome infections. AREAS COVERED : Several approaches used in the synthesis of praziquantel aimed at reducing the time and cost of production, the toxicity and experimental harsh conditions are discussed. Also, patented methods involved in the pharmaceutical reformulation of praziquantel in the treatment of diverse endoparasitic infestations are reported. Additionally, future perspectives in terms of nanomedicine approach in the formulation of praziquantel are highlighted. EXPERT OPINION : Lipid-based nanosystems (LBNSs) formulations can be used to overcome the shortcomings associated with the use of praziquantel in the schistosomiasis treatment due to their amphipathic nature. This could be a promising vehicle for the delivery of praziquantel, which could in turn improve the bioavailability, as well as reduce the frequent dose of the drug and improve patient compliance. This may sustain the release of the drug and improve the rapid conversion of the drug into inactive metabolite due to rapid metabolism. Additionally, LBNSs approach could increase and improve the lipophilicity of the drug, which could make it easier to interact with the hydrophobic cores of the worm tegument.
Collapse
Affiliation(s)
- Tayo A Adekiya
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pradeep Kumar
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pierre P D Kondiah
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Viness Pillay
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yahya E Choonara
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
6
|
Zamir M, Shah K, Nadeem F, Bajuri MY, Ahmadian A, Salahshour S, Ferrara M. Threshold conditions for global stability of disease free state of COVID-19. RESULTS IN PHYSICS 2021; 21:103784. [PMID: 36465528 PMCID: PMC9673815 DOI: 10.1016/j.rinp.2020.103784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 05/03/2023]
Abstract
This article focus the elimination and control of the infection caused by COVID-19. Mathematical model of the disease is formulated. With help of sensitivity analysis of the reproduction number the most sensitive parameters regarding transmission of infection are found. Consequently strategies for the control of infection are proposed. Threshold condition for global stability of the disease free state is investigated. Finally, using Matlab numerical simulations are produced for validation of theocratical results.
Collapse
Affiliation(s)
- Muhammad Zamir
- Department of Mathematics, University of Science and Technology, Bannu, Khyber Pakhtunkhwa, Pakistan
| | - Kamal Shah
- Department of Mathematics, University of Malakand, Chakdara, Dir(L), Khyber Pakhtunkhwa, Pakistan
| | - Fawad Nadeem
- Department of Mathematics, University of Science and Technology, Bannu, Khyber Pakhtunkhwa, Pakistan
| | - Mohd Yazid Bajuri
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia(UKM), Kuala Lumpur, Malaysia
| | - Ali Ahmadian
- Institute of IR 4.0, The National University of Malaysia, 43600, UKM, Bangi, Malaysia
| | - Soheil Salahshour
- Faculty of Engineering and Natural Sciences, Bahcesehir University, Istanbul, Turkey
| | - Massimiliano Ferrara
- ICRIOS - The Invernizzi Centre for Research in Innovation, Organization, Strategy and Entrepreneurship, Bocconi University, Department of Management and Technology Via Sarfatti, 25 20136 Milano (MI), Italy
| |
Collapse
|
7
|
Zamir M, Nadeem F, Abdeljawad T, Hammouch Z. Threshold condition and non pharmaceutical interventions's control strategies for elimination of COVID-19. RESULTS IN PHYSICS 2021; 20:103698. [PMID: 36466743 PMCID: PMC9673771 DOI: 10.1016/j.rinp.2020.103698] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 05/23/2023]
Abstract
In this work we focus on the eradication of the COVID-19 infection with the help of almost Non Pharmaceutical Interventions(NPIs), using mathematical modelling. First the basic reproduction number R 0 is investigated. Then, on the basis of sensitivity test of R 0 , the most active/sensitive parameters are presented in detail. Non Pharmaceutical Interventions(NPIs) are applied to control the sensitive parameters. The major NPIs are, stay home (isolation), sanitizers (wash hands), Treatment of side effects of infection, like throat infection etc and face mask. These NPIs helps in mitigation and reducing the size of outbreak of the disease. Threshold condition for global stability of the disease free state is investigated.The NPI's are used in different ratios to formulate a strategy. The results of these strategies are validated using Matlab software.
Collapse
Affiliation(s)
- Muhammad Zamir
- Department of Mathematics, University of Science and Technology Bannu, Khyber Pakhtunkhwa, Pakistan
| | - Fawad Nadeem
- Department of Mathematics, University of Science and Technology Bannu, Khyber Pakhtunkhwa, Pakistan
| | - Thabet Abdeljawad
- Department of Mathematics and General Sciences, Prince Sultan University Riyadh, Saudi Arabia
- Department of Medical Research, China Medical University, Taichung 40402, Taiwan
| | - Zakia Hammouch
- Division of Applied Mathematics, Thu Dau Mot University, Binh Duong Province, Viet Nam
| |
Collapse
|
8
|
Can We Harness Immune Responses to Improve Drug Treatment in Leishmaniasis? Microorganisms 2020; 8:microorganisms8071069. [PMID: 32709117 PMCID: PMC7409143 DOI: 10.3390/microorganisms8071069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/12/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023] Open
Abstract
Leishmaniasis is a vector-borne parasitic disease that has been neglected in priority for control and eradication of malaria, tuberculosis, and HIV/AIDS. Collectively, over one seventh of the world’s population is at risk of being infected with 0.7–1.2 million new infections reported annually. Clinical manifestations range from self-healing cutaneous lesions to fatal visceral disease. The first anti-leishmanial drugs were introduced in the 1950′s and, despite several shortcomings, remain the mainstay for treatment. Regardless of this and the steady increase in infections over the years, particularly among populations of low economic status, research on leishmaniasis remains under funded. This review looks at the drugs currently in clinical use and how they interact with the host immune response. Employing chemoimmunotherapeutic approaches may be one viable alternative to improve the efficacy of novel/existing drugs and extend their lifespan in clinical use.
Collapse
|
9
|
Garg G, Ali V, Singh K, Gupta P, Ganguly A, Sahasrabuddhe AA, Das P. Quantitative secretome analysis unravels new secreted proteins in Amphotericin B resistant Leishmania donovani. J Proteomics 2019; 207:103464. [PMID: 31357030 DOI: 10.1016/j.jprot.2019.103464] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/24/2022]
Abstract
Leishmaniasis is second most neglected disease after malaria and seems to be a worldwide concern because of increased drug resistance and non-availability of approved vaccine. The underlying molecular mechanism of drug resistance (Amp B) in Leishmania parasites still remains elusive. Herein, the present study investigated differentially expressed secreted proteins of Amphotericin B sensitive (S) and resistant (R) isolate of Leishmania donovani by using label free quantitative LC-MS/MS approach. A total of 406 differentially expressed secreted proteins were found between sensitive (S) and resistant (R) isolate. Among 406 proteins, 32 were significantly up regulated (>2.0 fold) while 22 were down regulated (<0.5 fold) in resistant isolate of L. donovani. Further, differentially expressed proteins were classified into 11 various biological processes. Interestingly, identified up regulated proteins in resistant parasites were dominated in carbohydrate metabolism, stress response, transporters and proteolysis. Western blot and enzymatic activity of identified proteins validate our proteomic findings. Finally, our study demonstrated some new secreted proteins associated with Amp B resistance which provides a basis for further investigations to understand the role of proteins in L. donovani. BIOLOGICAL SIGNIFICANCE: Although great advances have been achieved in the diagnosis and treatment of leishmaniasis, still drug resistance is major hurdle in control of disease. Present study will enhance the deeper understanding of altered metabolic pathways involved in Amp B resistance mechanism and provide possible new proteins which can be potential candidate either for exploring as new drug target or vaccine. Protein-protein interactions highlighted the up-regulated metabolic pathways in resistant parasites which further unravel the adaptive mechanism of parasites.
Collapse
Affiliation(s)
- Gaurav Garg
- Laboratory of Molecular Biochemistry and Cell Biology, Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, India; Department of Biotechnology, National Institute of Pharmaceutical Education and Research, EPIP Complex, Hajipur 844102, India
| | - Vahab Ali
- Laboratory of Molecular Biochemistry and Cell Biology, Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, India; Department of Biotechnology, National Institute of Pharmaceutical Education and Research, EPIP Complex, Hajipur 844102, India.
| | - Kuljit Singh
- Laboratory of Molecular Biochemistry and Cell Biology, Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, India; Department of Biotechnology, National Institute of Pharmaceutical Education and Research, EPIP Complex, Hajipur 844102, India
| | - Parool Gupta
- Laboratory of Molecular Biochemistry and Cell Biology, Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, India
| | - Ashish Ganguly
- CSIR- Institute of Microbial Technology, Chandigarh, India
| | - Amogh A Sahasrabuddhe
- Molecular and Structural Biology, CSIR-Central Drug Research Institute, Lucknow, India
| | - Pradeep Das
- Division of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna 800007, India
| |
Collapse
|
10
|
Antwi CA, Amisigo CM, Adjimani JP, Gwira TM. In vitro activity and mode of action of phenolic compounds on Leishmania donovani. PLoS Negl Trop Dis 2019; 13:e0007206. [PMID: 30802252 PMCID: PMC6405172 DOI: 10.1371/journal.pntd.0007206] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/07/2019] [Accepted: 01/30/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Leishmaniasis is a disease caused by the protozoan parasite, Leishmania. The disease remains a global threat to public health requiring effective chemotherapy for control and treatment. In this study, the effect of some selected phenolic compounds on Leishmania donovani was investigated. The compounds were screened for their anti-leishmanial activities against promastigote and intracellular amastigote forms of Leishmania donovani. METHODOLOGY/PRINCIPAL FINDINGS The dose dependent effect and cytotoxicity of the compounds were determined by the MTT assay. Flow cytometry was used to determine the effect of the compounds on the cell cycle. Parasite morphological analysis was done by microscopy and growth kinetic studies were conducted by culturing cells and counting at 24 hours intervals over 120 hours. The cellular levels of iron in promastigotes treated with compounds was determined by atomic absorption spectroscopy and the effect of compounds on the expression of iron dependent enzymes was investigated using RT-qPCR. The IC50 of the compounds ranged from 16.34 μM to 198 μM compared to amphotericin B and deferoxamine controls. Rosmarinic acid and apigenin were the most effective against the promastigote and the intracellular amastigote forms. Selectivity indexes (SI) of rosmarinic acid and apigenin were 15.03 and 10.45 respectively for promastigotes while the SI of 12.70 and 5.21 respectively was obtained for intracellular amastigotes. Morphologically, 70% of rosmarinic acid treated promastigotes showed rounded morphology similar to the deferoxamine control. About 30% of cells treated with apigenin showed distorted cell membrane. Rosmarinic acid and apigenin induced cell arrest in the G0/G1 phase in promastigotes. Elevated intracellular iron levels were observed in promastigotes when parasites were treated with rosmarinic acid and this correlated with the level of expression of iron dependent genes. CONCLUSIONS/SIGNIFICANCE The data suggests that rosmarinic acid exerts its anti-leishmanial effect via iron chelation resulting in variable morphological changes and cell cycle arrest.
Collapse
Affiliation(s)
- Christine Achiaa Antwi
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Cynthia Mmalebna Amisigo
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Jonathan Partt Adjimani
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Theresa Manful Gwira
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| |
Collapse
|
11
|
Garg G, Singh K, Ali V. Proteomic approaches unravel the intricacy of secreted proteins of Leishmania: An updated review. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2018; 1866:913-923. [DOI: 10.1016/j.bbapap.2018.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/16/2018] [Accepted: 05/22/2018] [Indexed: 02/03/2023]
|
12
|
Amphotericin B for treatment of visceral leishmaniasis: systematic review and meta-analysis of prospective comparative clinical studies including dose-ranging studies. Clin Microbiol Infect 2018; 24:591-598. [DOI: 10.1016/j.cmi.2017.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/02/2017] [Accepted: 11/05/2017] [Indexed: 02/06/2023]
|
13
|
Abstract
Treatment of Visceral Leishmaniasis (VL), a neglected tropical disease, is very challenging with few treatment options. Long duration of treatment and drug toxicity further limit the target of achieving VL elimination. Chemotherapy remains the treatment of choice. Single dose of liposomal amphotericin B (LAmB) and multidrug therapy (LAmB + miltefosine, LAmB + paromomycin (PM), or miltefosine + PM) are recommended treatment regimen for treatment of VL in Indian sub-continent. Combination therapy of pentavalent antimonials (Sbv) and PM in East Africa and LAmB in the Mediterranean region/South America remains the treatment of choice. Various drugs having anti-leishmania properties are in preclinical phase and need further development. An effective treatment and secondary prophylaxis of HIV-VL co-infection should be developed to decrease treatment failure and drug resistance.
Collapse
Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005
| | - Anup Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005
| |
Collapse
|
14
|
Global Analysis and Optimal Control of a Periodic Visceral Leishmaniasis Model. MATHEMATICS 2017. [DOI: 10.3390/math5040080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
15
|
Ansari MY, Dikhit MR, Sahoo GC, Ali V, Das P. Recent advancement and treatment of leishmaniasis based on pharmacoinformatics approach: Current and future outlook. GENE REPORTS 2017. [DOI: 10.1016/j.genrep.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
16
|
Pandey K, Pal B, Siddiqui NA, Rabi Das VN, Murti K, Lal CS, Verma N, Babu R, Ali V, Kumar R, Das P. Efficacy and Safety of Liposomal Amphotericin B for Visceral Leishmaniasis in Children and Adolescents at a Tertiary Care Center in Bihar, India. Am J Trop Med Hyg 2017; 97:1498-1502. [PMID: 29016288 DOI: 10.4269/ajtmh.17-0094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Liposomal amphotericin B is being used increasingly to reduce the burden of kala-azar from the Indian subcontinent. There are studies which have evaluated efficacy and safety of liposomal amphotericin B for visceral leishmaniasis in all age groups. However, the only study that specifically addressed treatment of childhood visceral leishmaniasis did not include all ages or document renal and liver function. We, therefore, felt it was important to reassess the efficacy and safety of single dose liposomal amphotericin B in children and adolescents. A total of 100 parasitologically confirmed visceral leishmaniasis patients aged < 15 years were included in this study. Participants consisted of 65 males and 35 females. All of them had come from the endemic region of Bihar. They were administered one dose intravenous infusion of liposomal amphptericin B at 10 mg/kg body weight. Efficacy was assessed as initial and final cure at 1 and 6 months, respectively, and safety of all participants who were recruited in the study. The initial and final cure rate by per protocol analysis was 100% and 97.9%, respectively. Chills and rigors were the most commonly occurring adverse events (AEs). All the AEs were mild in intensity, and none of the patients experienced any serious AEs. No patients developed nephrotoxicity. Our finding indicates that liposomal amphotericin B at 10 mg/kg body weight is safe and effective in children. Results of our study support the use of single dose liposomal amphotericin B in all age group populations for elimination of kala-azar from the Indian subcontinent.
Collapse
Affiliation(s)
- Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian, Council of Medical Research), Patna, Bihar, India
| | - Biplab Pal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Niyamat Ali Siddiqui
- Department of Biostatistics, Rajendra Memorial Research Institute of Medical Sciences (Indian Council, of Medical Research), Patna, Bihar, India
| | - Vidya Nand Rabi Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian, Council of Medical Research), Patna, Bihar, India
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Chandra Shekhar Lal
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, (Indian Council of Medical Research), Patna, Bihar, India
| | - Neena Verma
- Department of Pathology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of, Medical Research), Patna, Bihar, India
| | - Rajendra Babu
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Vahab Ali
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, (Indian Council of Medical Research), Patna, Bihar, India
| | - Rakesh Kumar
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian, Council of Medical Research), Patna, Bihar, India
| | - Pradeep Das
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences (Indian, Council of Medical Research), Patna, Bihar, India
| |
Collapse
|
17
|
Romero GAS, Costa DL, Costa CHN, de Almeida RP, de Melo EV, de Carvalho SFG, Rabello A, de Carvalho AL, Sousa ADQ, Leite RD, Lima SS, Amaral TA, Alves FP, Rode J. Efficacy and safety of available treatments for visceral leishmaniasis in Brazil: A multicenter, randomized, open label trial. PLoS Negl Trop Dis 2017; 11:e0005706. [PMID: 28662034 PMCID: PMC5507560 DOI: 10.1371/journal.pntd.0005706] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/12/2017] [Accepted: 06/12/2017] [Indexed: 11/28/2022] Open
Abstract
Background There is insufficient evidence to support visceral leishmaniasis (VL) treatment recommendations in Brazil and an urgent need to improve current treatments. Drug combinations may be an option. Methods A multicenter, randomized, open label, controlled trial was conducted in five sites in Brazil to evaluate efficacy and safety of (i) amphotericin B deoxycholate (AmphoB) (1 mg/kg/day for 14 days), (ii) liposomal amphotericin B (LAMB) (3 mg/kg/day for 7 days) and (iii) a combination of LAMB (10 mg/kg single dose) plus meglumine antimoniate (MA) (20 mg Sb+5/kg/day for 10 days), compared to (iv) standard treatment with MA (20 mg Sb+5/kg/day for 20 days). Patients, aged 6 months to 50 years, with confirmed VL and without HIV infection were enrolled in the study. Primary efficacy endpoint was clinical cure at 6 months. A planned efficacy and safety interim analysis led to trial interruption. Results 378 patients were randomized to the four treatment arms: MA (n = 112), AmphoB (n = 45), LAMB (n = 109), or LAMB plus MA (n = 112). A high toxicity of AmphoB prompted an unplanned interim safety analysis and this treatment arm was dropped. Per intention-to-treat protocol final analyses of the remaining 332 patients show cure rates at 6 months of 77.5% for MA, 87.2% for LAMB, and 83.9% for LAMB plus MA, without statistically significant differences between the experimental arms and comparator (LAMB: 9.7%; CI95% -0.28 to 19.68, p = 0.06; LAMB plus MA: 6.4%; CI95% -3.93 to 16.73; p = 0.222). LAMB monotherapy was safer than MA regarding frequency of treatment-related adverse events (AE) (p = 0.045), proportion of patients presenting at least one severe AE (p = 0.029), and the proportion of AEs resulting in definitive treatment discontinuation (p = 0.003). Conclusions Due to lower toxicity and acceptable efficacy, LAMB would be a more suitable first line treatment for VL than standard treatment. ClinicalTrials.gov identification number: NCT01310738. Trial registration ClinicalTrials.gov NCT01310738 Visceral leishmaniasis remains a worldwide public health concern with high mortality even when proper treatment is instituted. There is a need to develop efficacious, safer and shorter treatment alternatives as the current options suffer from high toxicity and long treatment duration. Combination therapies emerge as an alternative, and WHO has encouraged the conduct of studies to evaluate drug combinations where evidence for current treatment regimens is not available. In Brazil, there is no local evidence to support the current treatment recommendations. Therefore, a clinical trial was conducted in five hospitals in Brazil to evaluate the efficacy and safety of the current available treatments—meglumine antimoniate, amphotericin B deoxycholate and liposomal amphotericin B—and of a combination of liposomal amphotericin B, single dose, and meglumine antimoniate, in a shorter administration regimen. Preliminary safety results led to the discontinuation of the amphotericin B deoxycholate treatment arm and a planned interim analysis resulted in the trial interruption. The final results, comparing liposomal amphotericin B and liposomal amphotericin B plus meglumine antimoniate to the standard meglumine antimoniate treatment, did not show a statistically significant difference in cure rates, though cure rate was higher in the liposomal amphotericin B group. Liposomal amphotericin B treatment showed a better safety profile compared to meglumine antimoniate. These results will support future changes in treatment protocols in Brazil and potentially in Latin America.
Collapse
Affiliation(s)
| | - Dorcas Lamounier Costa
- Universidade Federal do Piauí, Hospital de Doenças Tropicais Natan Portela, Teresina, Piauí, Brasil
| | | | | | - Enaldo Viera de Melo
- Universidade Federal de Sergipe, Hospital Universitário, Aracaju, Sergipe, Brasil
| | - Sílvio Fernando Guimarães de Carvalho
- Departamento de Doenças Infecciosas, Hospital Universitário Clemente de Faria, Universidade Estadual de Montes Claros, Montes Claros, Minas Gerais, Brasil
| | - Ana Rabello
- Laboratório de Pesquisa Clínica, e Políticas Públicas em Doenças Infecciosas e Parasitárias, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil
| | - Andréa Lucchesi de Carvalho
- Hospital Infantil João Paulo II, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | | | - Robério Dias Leite
- Universidade Federal do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brasil
| | - Simone Soares Lima
- Universidade Federal do Piauí – Hospital Infantil Lucídio Portela, Teresina, Piauí, Brasil
| | - Thais Alves Amaral
- Plataforma de Pesquisa Clínica, Vice-Presidência de Pesquisa e Laboratórios de Referência, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Joelle Rode
- Drugs for Neglected Diseases initiative (DNDi), Rio de Janeiro, Rio de Janeiro, Brasil
| | | |
Collapse
|
18
|
Agusto FB, ELmojtaba IM. Optimal control and cost-effective analysis of malaria/visceral leishmaniasis co-infection. PLoS One 2017; 12:e0171102. [PMID: 28166308 PMCID: PMC5293207 DOI: 10.1371/journal.pone.0171102] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/16/2017] [Indexed: 11/23/2022] Open
Abstract
In this paper, a deterministic model involving the transmission dynamics of malaria/visceral leishmaniasis co-infection is presented and studied. Optimal control theory is then applied to investigate the optimal strategies for curtailing the spread of the diseases using the use of personal protection, indoor residual spraying and culling of infected reservoirs as the system control variables. Various combination strategies were examined so as to investigate the impact of the controls on the spread of the disease. And we investigated the most cost-effective strategy of all the control strategies using three approaches, the infection averted ratio (IAR), the average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER). Our results show that the implementation of the strategy combining all the time dependent control variables is the most cost-effective control strategy. This result is further emphasized by using the results obtained from the cost objective functional, the ACER, and the ICER.
Collapse
Affiliation(s)
- Folashade B. Agusto
- Department of Ecology and Evolutionary Biology, University of Kansas, Lawrence, 66045, Kansas, United States of America
| | - Ibrahim M. ELmojtaba
- Department of Mathematics and Statistics, College of Sciences, Sultan Qaboos University, P.O.Box 36, Al Khodh, Oman
| |
Collapse
|
19
|
Davidson RN. Leishmaniasis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00123-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
20
|
Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2016; 63:e202-e264. [PMID: 27941151 DOI: 10.1093/cid/ciw670] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022] Open
Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
Collapse
Affiliation(s)
- Naomi Aronson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Michael Libman
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Peter Weina
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Selma Jeronimo
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alan Magill
- Bill and Melinda Gates Foundation, Seattle, Washington
| |
Collapse
|
21
|
Duthie MS, Favila M, Hofmeyer KA, Tutterrow YL, Reed SJ, Laurance JD, Picone A, Guderian J, Bailor HR, Vallur AC, Liang H, Mohamath R, Vergara J, Howard RF, Coler RN, Reed SG. Strategic evaluation of vaccine candidate antigens for the prevention of Visceral Leishmaniasis. Vaccine 2016; 34:2779-86. [PMID: 27142329 PMCID: PMC4889780 DOI: 10.1016/j.vaccine.2016.04.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/18/2016] [Accepted: 04/23/2016] [Indexed: 11/03/2022]
Abstract
Infection with Leishmania parasites results in a range of clinical manifestations and outcomes, the most severe of which is visceral leishmaniasis (VL). Vaccination will likely provide the most effective long-term control strategy, as the large number of vectors and potential infectious reservoirs renders sustained interruption of Leishmania parasite transmission extremely difficult. Selection of the best vaccine is complicated because, although several vaccine antigen candidates have been proposed, they have emerged following production in different platforms. To consolidate the information that has been generated into a single vaccine platform, we expressed seven candidates as recombinant proteins in E. coli. After verifying that each recombinant protein could be recognized by VL patients, we evaluated their protective efficacy against experimental L. donovani infection of mice. Administration in formulation with the Th1-potentiating adjuvant GLA-SE indicated that each antigen could elicit antigen-specific Th1 responses that were protective. Considering the ability to reduce parasite burden along with additional factors such as sequence identity across Leishmania species, we then generated a chimeric fusion protein comprising a combination of the 8E, p21 and SMT proteins. This E. coli –expressed fusion protein was also demonstrated to protect against L. donovani infection. These data indicate a novel recombinant vaccine antigen with the potential for use in VL control programs.
Collapse
Affiliation(s)
- Malcolm S Duthie
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA.
| | - Michelle Favila
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Kimberley A Hofmeyer
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Yeung L Tutterrow
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Steven J Reed
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - John D Laurance
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Alessandro Picone
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Jeffrey Guderian
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - H Remy Bailor
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Aarthy C Vallur
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Hong Liang
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Raodoh Mohamath
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Julie Vergara
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Randall F Howard
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Rhea N Coler
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| | - Steven G Reed
- Infectious Disease Research Institute, 1616 Eastlake Avenue East, Suite 400, Seattle, WA 98102, USA
| |
Collapse
|
22
|
Singh OP, Singh B, Chakravarty J, Sundar S. Current challenges in treatment options for visceral leishmaniasis in India: a public health perspective. Infect Dis Poverty 2016; 5:19. [PMID: 26951132 PMCID: PMC4782357 DOI: 10.1186/s40249-016-0112-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/02/2016] [Indexed: 12/31/2022] Open
Abstract
Visceral leishmaniasis (VL) is a serious parasitic disease causing considerable mortality and major disability in the Indian subcontinent. It is most neglected tropical disease, particularly in terms of new drug development for the lack of financial returns. An elimination campaign has been running in India since 2005 that aim to reduce the incidence of VL to below 1 per 10,000 people at sub-district level. One of the major components in this endeavor is reducing transmission through early case detection followed by complete treatment. Substantial progress has been made during the recent years in the area of VL treatment, and the VL elimination initiatives have already saved many lives by deploying them effectively in the endemic areas. However, many challenges remain to be overcome including availability of drugs, cost of treatment (drugs and hospitalization), efficacy, adverse effects, and growing parasite resistance. Therefore, better emphasis on implementation research is urgently needed to determine how best to deliver existing interventions with available anti-leishmanial drugs. It is essential that the new treatment options become truly accessible, not simply available in endemic areas so that they may promote healing and save lives. In this review, we highlight the recent advancement and challenges in current treatment options for VL in disease endemic area, and discuss the possible strategies to improve the therapeutic outcome.
Collapse
Affiliation(s)
- Om Prakash Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Bhawana Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Jaya Chakravarty
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| |
Collapse
|
23
|
Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
| |
Collapse
|
24
|
Ansari MY, Equbal A, Dikhit MR, Mansuri R, Rana S, Ali V, Sahoo GC, Das P. Establishment of correlation between in-silico and in-vitro test analysis against Leishmania HGPRT to inhibitors. Int J Biol Macromol 2015; 83:78-96. [PMID: 26616453 DOI: 10.1016/j.ijbiomac.2015.11.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
Hypoxanthine Phosphoribosyltransferase (HGPRT; EC 2.4.2.8) is a central enzyme in the purine recycling pathway of all protozoan parasites. Protozoan parasites cannot synthesize purine bases (DNA/RNA) which is essential for survival as lack of de-novo pathway. Thus its good target for drug design and discovery as inhibition leads to cessation of replication. PRTase (transferase enzyme) has common PRTase type I folding pattern domain for its activities. Genomic studies revealed the sequence pattern and identified highly conserved residues that catalyzed the reaction in protozoan parasites. A recombinant protein has 24 kDa molecular mass (rLdHGPRT) was cloned, expressed and purified for testing of guanosine monophosphate (GMP) analogous compounds in-vitro by spectroscopically to the rLdHGPRT, lysates protein and MTT assay on Leishmania donovani. The predicted inhibitors of different libraries were screen into FlexX. The reported inhibitors were tested in-vitro. The 2'-deoxyguanosine 5'-diphosphate (DGD) (IC50 value 12.5 μM) is two times more effective when compared to guanosine-5'-diphosphate sodium (GD). Interestingly, LdHGPRT complex has shown stable after 24 ns in molecular dynamics simulation with interacting amino acids are Glu125, Ile127, Lys87 and Val186. QSAR studies revealed the correlation between predicted and experimental values has shown R2 0.998. Concludes that inversely proportional to their docked score with activities.
Collapse
Affiliation(s)
- Md Yousuf Ansari
- Pharmacoinformatics Department, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur 844102, India; BioMedical Informatics Division, Rajendra Memorial Research Institute of Medical Sciences, Agam Kuan, Patna 800007, India
| | - Asif Equbal
- Biochemistry Department, Rajendra Memorial Research Institute of Medical Sciences, Agam Kuan, Patna 800007, India
| | - Manas Ranjan Dikhit
- BioMedical Informatics Division, Rajendra Memorial Research Institute of Medical Sciences, Agam Kuan, Patna 800007, India
| | - Rani Mansuri
- Pharmacoinformatics Department, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur 844102, India; BioMedical Informatics Division, Rajendra Memorial Research Institute of Medical Sciences, Agam Kuan, Patna 800007, India
| | - Sindhuprava Rana
- BioMedical Informatics Division, Rajendra Memorial Research Institute of Medical Sciences, Agam Kuan, Patna 800007, India
| | - Vahab Ali
- Biochemistry Department, Rajendra Memorial Research Institute of Medical Sciences, Agam Kuan, Patna 800007, India
| | - Ganesh Chandra Sahoo
- BioMedical Informatics Division, Rajendra Memorial Research Institute of Medical Sciences, Agam Kuan, Patna 800007, India.
| | - Pradeep Das
- Pharmacoinformatics Department, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur 844102, India; BioMedical Informatics Division, Rajendra Memorial Research Institute of Medical Sciences, Agam Kuan, Patna 800007, India
| |
Collapse
|
25
|
Goswami RP, Goswami RP, Das S, Satpati A, Rahman M. Short-Course Treatment Regimen of Indian Visceral Leishmaniasis with an Indian Liposomal Amphotericin B Preparation (Fungisome™). Am J Trop Med Hyg 2015; 94:93-8. [PMID: 26526926 DOI: 10.4269/ajtmh.14-0657] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 09/20/2015] [Indexed: 11/07/2022] Open
Abstract
India bears the burden of about half of global visceral leishmaniasis (VL) cases with emerging problems of stibanate resistance. Liposomal preparations have improved treatment outcome through shorter duration of therapy and lower toxicity compared with conventional amphotericin B. We report the efficacy of two short-course regimens of an Indian preparation of liposomal amphotericin B (Fungisome™) for VL caused by Leishmania donovani in India. An open-label, randomized, single-center comparative study was undertaken from 2008 to 2011, involving 120 treatment naive non-human immunodeficiency virus VL patients randomly allocated to two groups. Fungisome™ was given, in groups A (N = 60), 5 mg/kg daily for 2 days and B (N = 60), 7.5 mg/kg daily for 2 days, as intravenous infusion. Initial cure rate was 100% in both the groups after 1 month posttreatment. At 6 months after completion of treatment, definitive cure rate was group A 90% (54/60, 95% confidence interval (CI): 80.55-95.72%); group B: 100% (95% CI: 95.92-100%); (P = 0.027). No serious adverse events occurred in either group. The short-course, 2-day regimen of 15 mg/kg Fungisome™ infusion is easy to administer, effective, and safe for treatment of VL caused by L. donovani in India.
Collapse
Affiliation(s)
- Rama P Goswami
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, West Bengal, India; Department of Rheumatology, Institution of Post Graduate Medical Education and Research, West Bengal, India; Department of Medicine, ESI Hospital, Joka, West Bengal, India
| | - Rudra P Goswami
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, West Bengal, India; Department of Rheumatology, Institution of Post Graduate Medical Education and Research, West Bengal, India; Department of Medicine, ESI Hospital, Joka, West Bengal, India
| | - Sukhen Das
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, West Bengal, India; Department of Rheumatology, Institution of Post Graduate Medical Education and Research, West Bengal, India; Department of Medicine, ESI Hospital, Joka, West Bengal, India
| | - Aditya Satpati
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, West Bengal, India; Department of Rheumatology, Institution of Post Graduate Medical Education and Research, West Bengal, India; Department of Medicine, ESI Hospital, Joka, West Bengal, India
| | - Mehebubar Rahman
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, West Bengal, India; Department of Rheumatology, Institution of Post Graduate Medical Education and Research, West Bengal, India; Department of Medicine, ESI Hospital, Joka, West Bengal, India
| |
Collapse
|
26
|
Hussaini N, Lubuma JMS, Barley K, Gumel AB. Mathematical analysis of a model for AVL-HIV co-endemicity. Math Biosci 2015; 271:80-95. [PMID: 26596715 DOI: 10.1016/j.mbs.2015.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
A model for the transmission dynamics of Anthroponotic Visceral Leishmaniasis (AVL) and human immunodeficiency virus (HIV) in a population is developed and used to assess the impact of the spread of each disease on the overall transmission dynamics. As for other vector-borne disease models, the AVL component of the model undergoes backward bifurcation when the associated reproduction number of the AVL-only sub-model (denoted by RL) is less than unity. Uncertainty and sensitivity analyzes of the model, using data relevant to the dynamics of the two diseases in Ethiopia, show that the top three parameters that drive the AVL infection (with respect to the associated response function, RL) are the average number of times a sandfly bites humans per unit time (σV), carrying capacity of vectors (KV) and transmission probability from infected humans to susceptible sandflies (β2). The distribution of RL is RL∈[0.06,3.94] with a mean of RL=1.08. Furthermore, the top three parameters that affect HIV dynamics (with respect to the response function RH) are the transmission rate of HIV (βH), HIV-induced death rate (δH), and the modification parameter for the increase in infectiousness of AIDS individuals in comparison to HIV infected without clinical symptoms of AIDS (ωH). The distribution of RH is RH∈[0.88,2.79] with a mean of RH=1.46. The dominant parameters that affect the dynamics of the full VL-HIV model (with respect to the associated reproduction number, RLH, as the response function) are the transmission rate of HIV (βH), the average number of times a sandfly bites humans per unit time (σV), and HIV-induced death rate (δH) (the distribution of RLH is RLH∈[0.88,3.94] with a mean of RLH=1.64). Numerical simulations of the model show that the two diseases co-exist (with AVL dominating, but not driving HIV to extinction) whenever the reproduction number of each disease exceeds unity. It is shown that AVL can invade a population at HIV-endemic state if a certain threshold quantity, known as invasion reproduction number, exceeds unity.
Collapse
Affiliation(s)
- N Hussaini
- Department of Mathematics and Applied Mathematics, University of Pretoria, Pretoria 0002, South Africa; Department of Mathematical Sciences, Bayero University Kano, P.M.B. 3011, Kano, Nigeria
| | - J M-S Lubuma
- Department of Mathematics and Applied Mathematics, University of Pretoria, Pretoria 0002, South Africa
| | - K Barley
- Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, AZ, 85287 USA
| | - A B Gumel
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ 85287, USA; Extraordinary Professor, Department of Mathematics and Applied Mathematics, University of Pretoria, Pretoria 0002, South Africa.
| |
Collapse
|
27
|
Sundar S, Singh A, Rai M, Chakravarty J. Single-dose indigenous liposomal amphotericin B in the treatment of Indian visceral leishmaniasis: a phase 2 study. Am J Trop Med Hyg 2014; 92:513-7. [PMID: 25510715 DOI: 10.4269/ajtmh.14-0259] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Liposomal amphotericin B is an effective and safe alternative for the treatment of visceral leishmaniasis in the Indian subcontinent. In this study, we used a higher-dose regimen of an indigenously manufactured liposomal amphotericin B (FUNGISOME; L-AmBL), which was intended to improve the efficacy in terms of long-lasting cure rate. Thirty men and thirty women between 12 and 60 years old with parasitologically confirmed visceral leishmaniasis were enrolled in two cohorts of 15 patients each. Subjects in cohort I were administered one dose (10 mg/kg body weight) of L-AmBL intravenously. After the safety at this dose was confirmed in cohort I, patients were recruited in cohort II. They received one infusion of an escalated dose (15 mg/kg body weight). The safety of these two doses was evaluated over a period of 30 days, and efficacy was assessed for initial cure at day 30 and definitive cure at 6 months. FUNGISOME was found to be safe, with an initial cure rate of 100% at day 30 and a definitive cure rate of 93.3% at the 6-month follow-up in both the cohorts.
Collapse
Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Anup Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Madhukar Rai
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Jaya Chakravarty
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| |
Collapse
|
28
|
Sudarshan M, Singh T, Singh AK, Chourasia A, Singh B, Wilson ME, Chakravarty J, Sundar S. Quantitative PCR in epidemiology for early detection of visceral leishmaniasis cases in India. PLoS Negl Trop Dis 2014; 8:e3366. [PMID: 25503103 PMCID: PMC4263468 DOI: 10.1371/journal.pntd.0003366] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 10/23/2014] [Indexed: 12/04/2022] Open
Abstract
Introduction Studies employing serological, DTH or conventional PCR techniques suggest a vast proportion of Leishmania infected individuals living in regions endemic for Visceral Leishmaniasis (VL) remain asymptomatic. This study was designed to assess whether quantitative PCR (qPCR) can be used for detection of asymptomatic or early Leishmania donovani infection and as a predictor of progression to symptomatic disease. Methods The study included 1469 healthy individuals living in endemic region (EHC) including both serology-positive and -negative subjects. TaqMan based qPCR assay was done on peripheral blood of each subject using kDNA specific primers and probes. Results A large proportion of EHC 511/1469 (34.78%) showed qPCR positivity and 56 (3.81% of 1469 subjects) had more than 1 calculated parasite genome/ml of blood. However, the number of individuals with parasite load above 5 genomes/ml was only 20 (1.36% of 1469). There was poor agreement between serological testing and qPCR (k = 0.1303), and 42.89% and 31.83% EHC were qPCR positive in seropositive and seronegative groups, respectively. Ten subjects had developed to symptomatic VL after 12 month of their follow up examination, of which eight were initially positive according to qPCR and among these, five had high parasite load. Discussion Thus, qPCR can help us to detect significant early parasitaemia, thereby assisting us in recognition of potential progressors to clinical disease. This test could facilitate early intervention, decreased morbidity and mortality, and possibly interruption of disease transmission. Anthroponotic VL caused by Leishmania donovani in the Indian subcontinent accounts for 70% of the world burden of VL. Among the estimated 100,000 cases of VL acquired annually in India, 90% occur in the state of Bihar. Leishmania infection can result in either symptomatic or asymptomatic infection. L. donovani infection can also manifest as post-kala azar dermal leishmaniasis, a chronic cutaneous form thought to provide the reservoir for anthroponotic transmission of VL in regions endemic for this parasite species. We hypothesized that, in areas endemic for L. donovani, asymptomatic infections might also play a crucial role in disease transmission. This study describes use of quantitative PCR (qPCR) to determine the infection status in individuals living in an endemic region of India. We hypothesized that parasite load estimation by qPCR of peripheral blood cells among healthy individuals living in the endemic region might reveal the true frequency of infections through direct evidence of parasitemia. We reasoned this test would detect both asymptomatic non-progressors as well as asymptomatic individuals who will progress to fully symptomatic VL. Serologic testing by ELISA or DAT showed poor agreement with molecular detection of parasite DNA by qPCR, suggesting the tests differentiate between infection and immune response. Amongst ten healthy individuals who progressed to VL, only six were serologically positive whereas eight were initially qPCR positive, among whom five had high parasite loads in their blood. Thus, deployment of qPCR technique to estimate the presence and level of parasitemia in healthy individuals from Leishmania endemic regions may contribute to early case detection, thereby reducing morbidity and mortality. Consistent with the goals of the VL control and elimination program, this early intervention approach could help interrupt disease transmission.
Collapse
Affiliation(s)
- Medhavi Sudarshan
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Toolika Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Abhishek Kumar Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ankita Chourasia
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Bhawana Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Mary E Wilson
- Departments of Internal Medicine and Microbiology, University of Iowa and the VA Medical Center, Iowa City, Iowa, United States of America
| | - Jaya Chakravarty
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| |
Collapse
|
29
|
Hussain H, Al-Harrasi A, Al-Rawahi A, Green IR, Gibbons S. Fruitful decade for antileishmanial compounds from 2002 to late 2011. Chem Rev 2014; 114:10369-428. [PMID: 25253511 DOI: 10.1021/cr400552x] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Hidayat Hussain
- UoN Chair of Oman's Medicinal Plants and Marine Natural Products, University of Nizwa , P.O. Box 33, Birkat Al Mauz, Nizwa 616, Sultanate of Oman
| | | | | | | | | |
Collapse
|
30
|
Sundar S, Pandey K, Thakur CP, Jha TK, Das VNR, Verma N, Lal CS, Verma D, Alam S, Das P. Efficacy and safety of amphotericin B emulsion versus liposomal formulation in Indian patients with visceral leishmaniasis: a randomized, open-label study. PLoS Negl Trop Dis 2014; 8:e3169. [PMID: 25233346 PMCID: PMC4169371 DOI: 10.1371/journal.pntd.0003169] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/04/2014] [Indexed: 11/18/2022] Open
Abstract
Background India is home to 60% of the total global visceral leishmaniasis (VL) population. Use of long-term oral (e.g. miltefosine) and parenteral drugs, considered the mainstay for treatment of VL, is now faced with increased resistance, decreased efficacy, low compliance and safety issues. The authors evaluated the efficacy and safety of an alternate treatment option, i.e. single infusion of preformed amphotericin B (AmB) lipid emulsion (ABLE) in comparison with that of liposomal formulation (LAmB). Methods In this multicentric, open-label study, 500 patients with VL were randomly assigned in a 3∶1 ratio to receive 15 mg/kg single infusion of either ABLE (N = 376) or LAmB (N = 124). Initial cure (Day 30/45), clinical improvement (Day 30) and long term definitive cure (Day 180) were assessed. Findings A total of 326 (86.7%) patients in the ABLE group and 122 (98.4%) patients in the LAmB group completed the study. Initial cure was achieved by 95.9% of patients in the ABLE group compared to 100% in the LAmB group (p = 0.028; 95% CI: −0.0663, −0.0150). Clinical improvement was comparable between treatments (ABLE: 98.9% vs. LAmB: 98.4%). Definitive cure was achieved in 85.9% with ABLE compared to 98.4% with LAmB. Infusion-related pyrexia (37.2% vs. 32.3%) and chills (18.4% vs. 18.5%) were comparable between ABLE and LAmB, respectively. Treatment-related serious adverse events were fewer in ABLE (0.3%) compared to LAmB (1.6%). Two deaths occurred in the ABLE group, of which one was probably related to the study drug. Nephrotoxicity and hepatotoxicity was not observed in either group. Conclusions ABLE 15 mg/kg single infusion had favorable efficacy and was well tolerated. Considering the demographic profile of the population in this region, a single dose treatment offers advantages in terms of compliance, cost and applicability. Trial Registration www.clinicaltrials.govNCT00876824 Visceral leishmaniasis (VL) is highly prevalent in northeastern India, particularly the state of Bihar and its bordering areas with Bangladesh and Nepal. The current standards of treatment, namely, miltefosine (oral) and pentavalent antimonials (parenteral) have long treatment durations and are faced with increasing resistance, decreased efficacy, low compliance and safety issues. In this regard, lipid formulations of amphotericin B (AmB) have become an attractive treatment option due to their high efficacy, shorter treatment regimens and favorable safety profiles. This Phase III study evaluated the efficacy and safety of preformed AmB lipid emulsion (ABLE) versus liposomal AmB (LAmB) (both 15 mg/kg single dose infusions) in the treatment of VL. ABLE showed favorable efficacy measured in terms of initial cure at Day 30/45, and overall clinical improvement. ABLE was well tolerated and its adverse event profile was consistent with previously documented findings. Based on the favorable efficacy and safety profile of ABLE, and considering the demographic profile of the population in the endemic region, a single dose treatment may offer advantages in terms of compliance, cost and applicability.
Collapse
Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
- * E-mail:
| | | | - Tara Kant Jha
- Kalazar Research Centre, Brahmpura, Muzaffarpur, Bihar, India
| | - Vidya Nand Ravi Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Neena Verma
- Department of Pathology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Chandra Shekhar Lal
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Deepak Verma
- Kala-azar Medical Research Center, Muzaffarpur, Bihar, India
| | - Shahnawaz Alam
- Kala-azar Medical Research Center, Muzaffarpur, Bihar, India
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| |
Collapse
|
31
|
Duthie MS, Reed SG. The Emergence of Defined Subunit Vaccines for the Prevention of Leishmaniasis. CURRENT TROPICAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40475-014-0024-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
32
|
Abstract
Visceral leishmaniasis (VL), also known as Kala-Azar, is a disseminated protozoal infection caused principally by Leishmania donovani and Leishmania infantum (known as Leishmania chagasi in South America). The therapeutic options for VL are diverse and depend on different factors, such as the geographical area of the infection, development of resistance to habitual treatments, HIV co-infection, malnourishment and other concomitant infections. This article provides an exhaustive review of the literature regarding studies published on the treatment of VL, and gives therapeutic recommendations stratified according to their level of evidence, the species of Leishmania implicated and the geographical location of the infection.
Collapse
Affiliation(s)
- Begoña Monge-Maillo
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera de Colmenar Km 9,1, 28034, Madrid, Spain
| | | |
Collapse
|
33
|
Marking U, den Boer M, Das AK, Ahmed EM, Rollason V, Ahmed BN, Davidson RN, Ritmeijer K. Hypokalaemia-induced rhabdomyolysis after treatment of post-Kala-azar dermal Leishmaniasis (PKDL) with high-dose AmBisome in Bangladesh-a case report. PLoS Negl Trop Dis 2014; 8:e2864. [PMID: 24922279 PMCID: PMC4055542 DOI: 10.1371/journal.pntd.0002864] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | | | | | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Geneva, Switzerland
| | - Be-Nazir Ahmed
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Robert N Davidson
- Department of Infection and Tropical Medicine, Northwick Park Hospital, Harrow, United Kingdom
| | | |
Collapse
|
34
|
Species-directed therapy for leishmaniasis in returning travellers: a comprehensive guide. PLoS Negl Trop Dis 2014; 8:e2832. [PMID: 24787001 PMCID: PMC4006727 DOI: 10.1371/journal.pntd.0002832] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/14/2014] [Indexed: 02/06/2023] Open
Abstract
Background Leishmaniasis is increasingly reported among travellers. Leishmania species vary in sensitivity to available therapies. Fast and reliable molecular techniques have made species-directed treatment feasible. Many treatment trials have been designed poorly, thus developing evidence-based guidelines for species-directed treatment is difficult. Published guidelines on leishmaniasis in travellers do not aim to be comprehensive or do not quantify overall treatment success for available therapies. We aimed at providing comprehensive species-directed treatment guidelines. Methodology/Principal Findings English literature was searched using PubMed. Trials and observational studies were included if all cases were parasitologically confirmed, the Leishmania species was known, clear clinical end-points and time points for evaluation of treatment success were defined, duration of follow-up was adequate and loss to follow-up was acceptable. The proportion of successful treatment responses was pooled using mixed effects methods to estimate the efficacy of specific therapies. Final ranking of treatment options was done by an expert panel based on pooled efficacy estimates and practical considerations. 168 studies were included, with 287 treatment arms. Based on Leishmania species, symptoms and geography, 25 clinical categories were defined and therapy options ranked. In 12/25 categories, proposed treatment agreed with highest efficacy data from literature. For 5/25 categories no literature was found, and in 8/25 categories treatment advise differed from literature evidence. For uncomplicated cutaneous leishmaniasis, combination of intralesional antimony with cryotherapy is advised, except for L. guyanensis and L. braziliensis infections, for which systemic treatment is preferred. Treatment of complicated (muco)cutaneous leishmaniasis differs per species. For visceral leishmaniasis, liposomal amphotericin B is treatment of choice. Conclusions/Significance Our study highlights current knowledge about species-directed therapy of leishmaniasis in returning travellers and also demonstrates lack of evidence for treatment of several clinical categories. New data can easily be incorporated in the presented overview. Updates will be of use for clinical decision making and for defining further research. Human leishmaniasis is caused by unicellular parasites that are injected into the skin by sand-flies, small, flying insects. Many different Leishmania species cause various manifestations of disease, both of the skin and internal organs. Leishmaniasis is a curable disease but clear guidelines on the best available treatment are lacking. Leishmania species differ in sensitivity to available drugs. Until recently, identification of the infecting Leishmania parasite was laborious, thus therapy could not precisely be targeted to the infecting species, in contrast to many other infectious diseases. Nowadays, Leishmania parasites can be identified relatively easily with new DNA techniques. We studied efficacy of therapies for diseases due to different Leishmania species, limited to the English literature. Efficacy was summarized and presented in an easy to read format. Because of difficulties with identification of parasite species in earlier studies, quality of evidence was often limited. Our findings are a major help for clinicians to easily find optimal treatment for specific patients. Moreover, our results demonstrate where additional research is needed to further improve treatment of leishmaniasis.
Collapse
|
35
|
Safety and efficacy of single dose versus multiple doses of AmBisome for treatment of visceral leishmaniasis in eastern Africa: a randomised trial. PLoS Negl Trop Dis 2014; 8:e2613. [PMID: 24454970 PMCID: PMC3894173 DOI: 10.1371/journal.pntd.0002613] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022] Open
Abstract
Background Anti-leishmanial drug regimens that include a single dose AmBisome® could be suitable for eastern African patients with symptomatic visceral leishmaniasis (VL) but the appropriate single dose is unknown. Methodology A multi-centre, open-label, non-inferiority, randomized controlled trial with an adaptive design, was conducted to compare the efficacy and safety of a single dose and multiple doses of AmBisome® for the treatment of VL in eastern Africa. The primary efficacy endpoint was definitive cure (DC) at 6 months. Symptomatic patients with parasitologically-confirmed, non-severe VL, received a single dose of AmBisome® 7.5 mg/kg body weight or multiple doses, 7 times 3 mg/kg on days 1–5, 14, and 21. If interim analyses, evaluated 30 days after the start of treatment following 40 or 80 patients, showed the single dose gave significantly poorer parasite clearance than multiple doses at the 5% significance level, the single dose was increased by 2·5 mg/kg. In a sub-set of patients, parasite clearance was measured by quantitative reverse transcriptase (qRT) PCR. Principal Findings The trial was terminated after the third interim analysis because of low efficacy of both regimens. Based on the intention-to-treat population, DC was 85% (95%CI 73–93%), 40% (95%CI 19–64%), and 58% (95%CI 41–73%) in patients treated with multiple doses (n = 63), and single doses of 7·5 (n = 21) or 10 mg/kg (n = 40), respectively. qRT-PCR suggested superior parasite clearance with multiple doses as early as day 3. Safety data accorded with the drug label. Conclusions The tested AmBisome® regimens would not be suitable for VL treatment across eastern Africa. An optimal single dose regimen was not identified. Trials Registration www.clinicaltrials.govNCT00832208 Visceral leishmaniasis is a potentially fatal disease which affects 0.2–0.4 million people every year, principally in South-East Asia, Latin America or Eastern Africa. Currently the safest drug in use is AmBisome®, which cures 90% of patients in India at 5 mg/kg, and is even more effective at higher doses (10 mg/kg) or in combination with miltefosine or paromomycin. These regimens have been shown to be equally cost-effective in India. However, the drug requires a cold chain for storage and reconstitution prior to injection. Although it is licensed for use in eastern Africa, in practice it is mainly used as a second-line treatment. A small study carried out in Kenya indicated that a higher dose is necessary in eastern Africa in contrast to Asia. This study aimed to determine the minimum single dose that is safe and effective for treatment of eastern African VL patients so as to be used in simplified treatment regimens. However, the tested regimens were found to be ineffective, and an optimal single dose that could potentially be used in simplified treatment regimens was not identified.
Collapse
|
36
|
Murray HW. Progress in the treatment of a neglected infectious disease: visceral leishmaniasis. Expert Rev Anti Infect Ther 2014; 2:279-92. [PMID: 15482193 DOI: 10.1586/14787210.2.2.279] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Visceral leishmaniasis (kala-azar) is a disseminated intracellular protozoal infection. Most cases (90%) occur in the rural regions of five countries: India, Sudan, Nepal, Bangladesh and Brazil. As with other infectious diseases embedded in high-level poverty, developing and/or delivering new treatments for visceral leishmaniasis had been painfully slow or nonexistent. However, despite persistent unresolved obstacles (e.g., drug affordability), renewed interest in visceral leishmaniasis and numerous successful treatment trials have combined to turn a therapeutic corner in the past 5 years, yielding new alternatives to conventional pentavalent antimony. Advances include the use of low-cost generic pentavalent antimony, rediscovery of amphotericin B, short-course regimens via lipid formulations of amphotericin B, retesting injectible paromyomycin and, of clear-cut importance, identifying miltefosine (Impavido, Zentaris) as the first effective oral therapy for this neglected disease.
Collapse
Affiliation(s)
- Henry W Murray
- Department of Medicine, Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA.
| |
Collapse
|
37
|
Bottieau E, Vekemans M, Van Gompel A. Therapy of vector-borne protozoan infections in nonendemic settings. Expert Rev Anti Infect Ther 2014; 9:583-608. [DOI: 10.1586/eri.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
38
|
Zaghloul IY, Al-Jasser M. Effect of renal impairment on the pharmacokinetics of antimony in hamsters. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 98:793-800. [PMID: 15667712 DOI: 10.1179/000349804x3171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Renal failure was experimentally induced in 36 hamsters by intraperitoneal injection with uranyl nitrate (5 mg/kg). Twenty-four h later [during acute renal failure (ARF), as indicated by the serum concentrations of creatinine and urea nitrogen] or 72 h later [during chronic renal failure (CRF)] these hamsters plus 18, uninjected, control hamsters were each given a single, intramuscular dose of sodium stibogluconate (120 mg pentavalent antimony/kg). The pharmacokinetic parameters for the antimonial drug were calculated using a non-compartmental model. Urine was collected for 72 h after similar treatment with the antimonial drug, from another 30 hamsters (10 controls, 10 with ARF, and 10 with CRF), so that the fraction of the antimony administered that was subsequently excreted in the urine could be estimated. Compared with the controls, both the hamsters with ARF and those with CRF had significantly higher maximum concentrations of antimony (C(max)), significantly larger 'areas under the curve' for the plots of blood concentration v. time, and significantly longer plasma half-lives (P < 0.001 for each). The mean (S.D.) values of C(max), for example, were more than three-fold higher in the hamsters with ARF [467.5 (59.04) microg/ml] or CRF [461.1 (68.9) microg/ml] than in the controls [154.01 (17.3) microg/ml]. The systemic clearance of antimony was also significantly lower in the hamsters with CRF than in the control animals [0.051 (0.002) v. 0.296 (0.047) litres/h/kg; P < 0.01]. In addition, the fraction of the antimony administered that was excreted in urine was significantly lower in the animals with ARF (0.25) or CRF (0.08) than in the controls (0.37), indicating significant dysfunction of the kidneys in the hamsters injected with uranyl nitrate. It seems clear that, if severe toxicity is to be avoided, patients with renal dysfunction requiring treatment (for leishmaniasis) with sodium stibogluconate should be given lower doses than similar cases with normal kidney function.
Collapse
Affiliation(s)
- I Y Zaghloul
- Department of Clinical Pharmacy, College of Pharmacy, Science and Medical Studies, King Saud University, P. O. Box 22452, Riyadh 11495, Saudi Arabia.
| | | |
Collapse
|
39
|
Microalbuminuria and glomerular filtration rate in paediatric visceral leishmaniasis. BIOMED RESEARCH INTERNATIONAL 2013; 2013:498918. [PMID: 23865054 PMCID: PMC3705886 DOI: 10.1155/2013/498918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/10/2013] [Indexed: 11/17/2022]
Abstract
Visceral leishmaniasis, caused by Leishmania donovani, is a serious form of leishmaniasis and fatal if untreated. Nearly half of the VL cases are children. There are very few studies of renal function in pediatric visceral leishmaniasis. The aim of this study was to evaluate renal dysfunction by studying glomerular filtration rate (GFR), microalbuminuria, and microscopic examination of urine. Laboratory analysis was performed on blood and urine samples of 40 parasitologically confirmed pediatric VL cases. Laboratory data of urine examination showed albuminuria in 10% (4/40), white blood cells in 20% (8/40), hematuria in 10% (4/40), microalbuminuria in 37.5% (15/40), and decreased GFR in 27.5% (11/40). Renal involvement was manifested in most of the pediatric VL cases. These findings may help clinicians in decision making for safe and suitable antileishmanial treatment particularly in childhood VL.
Collapse
|
40
|
Oral mucosal involvement in visceral leishmaniasis. ASIAN PAC J TROP MED 2013; 6:249-50. [DOI: 10.1016/s1995-7645(13)60034-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/15/2012] [Accepted: 01/15/2013] [Indexed: 11/23/2022] Open
|
41
|
Hartley MA, Kohl K, Ronet C, Fasel N. The therapeutic potential of immune cross-talk in leishmaniasis. Clin Microbiol Infect 2013; 19:119-30. [DOI: 10.1111/1469-0691.12095] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 11/30/2022]
|
42
|
Balasegaram M, Ritmeijer K, Lima MA, Burza S, Ortiz Genovese G, Milani B, Gaspani S, Potet J, Chappuis F. Liposomal amphotericin B as a treatment for human leishmaniasis. Expert Opin Emerg Drugs 2012; 17:493-510. [PMID: 23167833 PMCID: PMC3518293 DOI: 10.1517/14728214.2012.748036] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Leishmaniasis is a parasitic disease transmitted by phlebotomine sandflies. Between 700,000 and 1.2 million cases of cutaneous leishmaniasis and between 200,000 and 400,000 cases of visceral leishmaniasis (VL), which is fatal if left untreated, occur annually worldwide. Liposomal amphotericin B (LAMB), alone or in combination with other drugs, has been extensively studied as VL treatment, but data on routine field use are limited, and several challenges to patients' access to this life-saving drug remain. AREAS COVERED This article provides a review of clinical studies on LAMB for VL and other forms of leishmaniasis. The current development of generic versions of LAMB and related challenges are also discussed. EXPERT OPINION LAMB proved to be highly efficacious and safe in over 8000 VL patients treated by MÉdecins Sans Frontières in South Asia, and its use was feasible even at primary healthcare level. Despite requiring higher doses, LAMB is the drug of choice to treat vulnerable groups (e.g., pregnant or HIV positive) and relapsing VL patients in East Africa. LAMB should be included in national VL guidelines and registered in all VL endemic countries. Its cost should be further reduced and regulatory pathways to prove bioequivalence for generic LAMB products should be implemented.
Collapse
|
43
|
Subclinical tumor lysis-like syndrome during treatment of visceral leishmaniasis with low-dose intermittent liposomal amphotericin B. Open Med (Wars) 2012. [DOI: 10.2478/s11536-011-0147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractWe retrospectively evaluated the rate of renal dysfunction during treatment with liposomal amphotericin B (L-AmB) (3–4 mg/kg, for 7–10 days) in nine consecutive patients with visceral leishmaniasis (VL). During the first week of treatment, 5 patients (56%) experienced transient deterioration of renal function, with a rise in serum creatinine to 1.27–2.44 times the baseline level, and a parallel elevation of uric acid levels without other metabolic or electrolyte disturbances. Serum renal function parameters were restored to normal levels after the completion of therapy, on day 21. These 5 patients had presented with prolonged fever and/or significant spleen enlargement, reflecting high parasite load. This observation suggests that treatment of VL with intermittent L-AmB causes a subclinical tumor lysis-like syndrome, especially in patients with high parasite load.
Collapse
|
44
|
Duthie MS, Raman VS, Piazza FM, Reed SG. The development and clinical evaluation of second-generation leishmaniasis vaccines. Vaccine 2011; 30:134-41. [PMID: 22085553 DOI: 10.1016/j.vaccine.2011.11.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/31/2011] [Accepted: 11/01/2011] [Indexed: 11/28/2022]
Abstract
Infection with Leishmania parasites results in a range of clinical manifestations and outcomes. Control of Leishmania parasite transmission is extremely difficult due to the large number of vectors and potential reservoirs, and none of the current treatments are ideal. Vaccination could be an effective strategy to provide sustained control. In this review, the current global situation with regard to leishmaniasis, the immunology of Leishmania infection and various efforts to identify second generation vaccine candidates are briefly discussed. The variety of clinical trials conducted using the only current second generation vaccine approved for clinical use, LEISH-F1+MPL-SE, are described. Given that epidemiological evidence suggests that reducing the canine reservoir also positively impacts human incidence, efforts at providing a vaccine for leishmaniasis in dogs are highlighted. Finally, potential refinements and surrogate markers that could expedite the introduction of a vaccine that can limit the severity and incidence of leishmaniasis are discussed.
Collapse
Affiliation(s)
- Malcolm S Duthie
- Infectious Disease Research Institute, 1124 Columbia St, Suite 400, Seattle, WA 98104, USA.
| | | | | | | |
Collapse
|
45
|
Dupnik KM, Nascimento EL, Rodrigues-Neto JF, Keesen T, Fernandes MZ, Duarte I, Jeronimo SMB. New challenges in the epidemiology and treatment of visceral leishmaniasis in periurban areas. Drug Dev Res 2011; 72:451-462. [PMID: 25821334 DOI: 10.1002/ddr.20452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Visceral leishmaniasis [VL] represents a major public health problem in many areas of the world. This review focuses on the impact of periurbanization on the epidemiology and treatment of VL, using Brazil as an example. VL continues to be mostly a disease of poverty with impact on families. However, the disease has expanded in Latin America, with foci reported as far south as Argentina. There is an increasing overlap of Leishmania infantum chagasi and HIV infections and other immunosuppressive conditions, resulting in VL emerging as an opportunistic infection. This new setting poses new challenges for VL disease control and patient management.
Collapse
Affiliation(s)
- Kathryn M Dupnik
- Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA ; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais, INCT-DT, Brazil
| | - Eliana L Nascimento
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais, INCT-DT, Brazil ; Department of Infectious Diseases, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Joao F Rodrigues-Neto
- Department of Biochemistry, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Tatjana Keesen
- Department of Biochemistry, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Maria Zélia Fernandes
- Health Post-Graduate Program, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil ; Department of Internal Medicine, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Iraci Duarte
- Fundação Nacional de Saúde, Secretaria de Saúde do Estado do Rio Grande do Norte, Natal, RN, Brazil
| | - Selma M B Jeronimo
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais, INCT-DT, Brazil ; Department of Biochemistry, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil ; Health Post-Graduate Program, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| |
Collapse
|
46
|
Abstract
The available treatment options for visceral leishmaniasis (VL) have problems relating to efficacy, adverse effects and cost, making treatment a complex issue. We review the evidence relating to the different methods of treatment in relation to - efficacy and toxicity of the drugs in different areas of the world; ability to monitor side effects, length of treatment; ability of patients to pay for and stay safe during treatment, ability of the healthcare services to give intramuscular, intravenous or oral therapy; the sex and child-bearing potential of the patient and the immune status of the patient. The high mortality of untreated/ poorly treated VL infection makes the decisions paramount, but a unified and coordinated response by each area is likely to be more effective and informative to future policies than an ad hoc response. For patients in resource-rich countries, liposomal amphotericin B appears to be the optimal treatment. In South Asia, miltefosine is being used; the combination of single dose liposomal amphotericin B and short course miltefosine looks encouraging but has the problem of potential reproductive toxicities in females. In Africa, the evidence to switch from SSG is not yet compelling. The need to monitor and plan for evolving drug failure, secondary to leishmania parasite resistance, is paramount. With a few drugs the options may be limited; however, we await key ongoing trials in both Africa and India to explore the effects of combination treatment. If safe and reliable combinations are revealed by the ongoing studies, it is far from clear as to whether this will avoid leishmania parasite resistance. The development of new drugs to add to the armamentarium is paramount. Lessons can be learnt from the management of diseases such as tuberculosis and malaria in terms of planning the switch to combination treatment. As important as establishing the best choice for specific antileishmanial agent is ensuring treatment centers, which can best manage the problems encountered during treatment, specifically malnutrition, bleeding, intercurrent infections, drug side effects and detecting and treating underlying immunosuppression.
Collapse
Affiliation(s)
- E M Moore
- Hospital for Tropical Diseases, University College London Hospital
| | | |
Collapse
|
47
|
Abstract
Liposomal amphotericin B has been used with increasing frequency to treat visceral leishmaniasis (VL). It is the treatment of choice for immunocompetent patients in the Mediterranean region and the preferred drug for HIV/VL co-infection. Although there is a regional variation in the susceptibility of the parasite a total dose of 20 mg/kg is effective in immunocompetent patients. Randomized clinical trials of liposomal amphotericin B in the treatment and secondary prophylaxis of HIV-VL coinfected patients is urgently needed to optimize treatment in this subset. With the availability of Liposomal amphotericin B at a preferential pricing in the endemic areas, short course combination therapy can become a viable alternative.
Collapse
Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, India
| | | |
Collapse
|
48
|
Matlashewski G, Arana B, Kroeger A, Battacharya S, Sundar S, Das P, Sinha PK, Rijal S, Mondal D, Zilberstein D, Alvar J. Visceral leishmaniasis: elimination with existing interventions. THE LANCET. INFECTIOUS DISEASES 2011; 11:322-5. [PMID: 21453873 DOI: 10.1016/s1473-3099(10)70320-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The world's burden of infectious diseases can be substantially reduced by more-effective use of existing interventions. Advances in case detection, diagnosis, and treatment strategies have made it possible to consider the elimination of visceral leishmaniasis in the Indian subcontinent. The priority must now be to effectively implement existing interventions at the community level by actively finding cases in endemic villages and treating them with single-dose liposomal amphotericin B at primary-health-care centres. Once the elimination target of one case per 10,000 population has been reached, combination therapies involving miltefosine and paromomycin can be introduced to ensure long-term availability of several drugs for visceral leishmaniasis and to protect against resistance.
Collapse
Affiliation(s)
- Greg Matlashewski
- Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Leishmaniasis: new insights from an old and neglected disease. Eur J Clin Microbiol Infect Dis 2011; 31:109-18. [PMID: 21533874 DOI: 10.1007/s10096-011-1276-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 04/12/2011] [Indexed: 02/06/2023]
Abstract
Leishmaniases are a clinically heterogeneous group of diseases caused by protozoa of the genus Leishmania. There is growing evidence that the true incidence of the disease is underestimated, especially in hyperendemic regions. Moreover, climate changes together with the increasing movement of humans and animals raise concerns about the possible introduction of Leishmania infection in previously spared areas. The disease is emerging in immunocompromised patients undergoing bone marrow or solid organ transplantation or treatment with biologic drugs. Furthermore, the deployment of military troops and travel to endemic areas are associated with the observation of a growing number of patients with cutaneous disease. Improvement in diagnostic methods, both in the field and in specialized laboratories, has been obtained through the implementation of molecular amplification methods and using the rK39 antigen as the substrate. Finally, new therapeutic approaches are gaining attention, such as the use of miltefosine for cutaneous leishmaniasis and paromomycin for visceral leishmaniasis, as well as the use of various antileishmanial drugs in combination.
Collapse
|
50
|
Abstract
PURPOSE OF REVIEW Several attempts have been made to combine drugs for treating visceral leishmaniasis, but only recently have effective drugs become available and combinations been tested systematically. RECENT FINDINGS Sequential treatments with liposomal amphotericin B followed by miltefosine or paromomycin (as short as 7 days), as well as the concomitant administration of miltefosine and paromomycin (for 10 days) are very effective in India (>95%). Sodium stibogluconate plus paromomycin for 17 days is more than 90% effective in East Africa. The shortened combination regimens are cost-effective in India. No combination has been tested so far in Brazil, Nepal and Bangladesh, although studies may be expected in the near future. No cost-effectiveness analysis has been done as yet outside India. SUMMARY There is evidence of high efficacy and benefits with sequential and co-administration treatments in India. More studies are needed in other endemic areas. Introducing combinations and scaling up their use will be challenging. Experience acquired with malaria may be useful. Proper monitoring of use and effects (efficacy and safety) will be required. Currently there are no options for fixed-dose combination treatments for leishmaniasis.
Collapse
|