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Hannan TB, Hossain Z, Roy U, Rahman SMM, Rahman MS, Sabah S, Rahat MA, Chowdhury R, Hossain F, Mondal D, Saha S, Haq T, Alam MR, Chowdhury FR. Successful treatment of recurrent visceral leishmaniasis relapse in an immunocompetent adult female with functional hypopituitarism in Bangladesh. PLoS Negl Trop Dis 2024; 18:e0012134. [PMID: 38669211 PMCID: PMC11051618 DOI: 10.1371/journal.pntd.0012134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Currently available treatment options are mostly effective in achieving long-term cure in visceral leishmaniasis (VL) patients. However, there have been reports of recurrence of this illness in both immunosuppressed and immunocompetent patients. CASE PRESENTATION We report the first case of recurrent VL relapse in a 19-year-old immunocompetent female with functional hypopituitarism (hypogonadotropic hypogonadism with central hypothyroidism) from Bangladesh, who has been treated three times previously with optimal dosage and duration- liposomal amphotericin B (LAmB) alone and in combination with miltefosine. We treated the patient successfully with a modified treatment regimen of 10 mg/kg body weight LAmB for two consecutive days along with oral miltefosine for seven days as loading dose. For secondary prophylaxis, the patient received 3 mg/kg body weight LAmB along with oral miltefosine for seven days monthly for five doses followed by hormonal replacement. The patient remained relapse free after 12 months of her treatment completion. CONCLUSION In the absence of protective vaccines against Leishmania species and standard treatment regimen, this modified treatment regimen could help the management of recurrent relapse cases.
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Affiliation(s)
- Tabiha Binte Hannan
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Zazeba Hossain
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Utshab Roy
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - S. M. Mahbubur Rahman
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Md Sadiqur Rahman
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Sadia Sabah
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Md. Abu Rahat
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research (icddrb), Dhaka, Bangladesh
| | - Rajashree Chowdhury
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research (icddrb), Dhaka, Bangladesh
| | - Faria Hossain
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research (icddrb), Dhaka, Bangladesh
| | - Dinesh Mondal
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research (icddrb), Dhaka, Bangladesh
| | - Shampa Saha
- Bangladesh Society of Infectious and Tropical Diseases (BSITD), Dhaka, Bangladesh
| | - Tahniyah Haq
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Md Rafiqul Alam
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Fazle Rabbi Chowdhury
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Yadav P, Azam M, Ramesh V, Singh R. Unusual Observations in Leishmaniasis-An Overview. Pathogens 2023; 12:pathogens12020297. [PMID: 36839569 PMCID: PMC9964612 DOI: 10.3390/pathogens12020297] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/06/2023] [Accepted: 01/19/2023] [Indexed: 02/15/2023] Open
Abstract
Leishmaniasis significantly affects the population of the tropics and subtropics. Clinical features and infective species of Leishmania are the primary factors driving the direction of diagnosis. The rise in incidences of atypical presentations present a challenge in patient treatment. Knowledge of unusual/rare presentations can aid in having a broader perspective for including the different aspects during the examination and thus avoid misdiagnosis. A comprehensive literature survey was performed to present the array of atypical presentations confounding clinicians which have been seen in leishmaniasis. Case reports of unusual findings based on the localizations and morphology of lesions and infective species and the predominant geographical sites over almost five decades highlight such presentations in the population. Information regarding the clinical features recorded in the patient and the chosen treatment was extracted to put forward the preferred drug regimen in such cases. This comprehensive review presents various unusual observations seen in visceral leishmaniasis, post-kala-azar dermal leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis. It highlights the need to consider such features in association with differential diagnosis to facilitate proper treatment of the patient.
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Affiliation(s)
- Priya Yadav
- ICMR-National Institute of Pathology, New Delhi 110029, India
- Manipal Academy of Higher Education, Manipal 576104, India
| | - Mudsser Azam
- ICMR-National Institute of Pathology, New Delhi 110029, India
| | - V Ramesh
- Department of Dermatology, ESIC Hospital, Faridabad 1210026, India
| | - Ruchi Singh
- ICMR-National Institute of Pathology, New Delhi 110029, India
- Correspondence: or
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Campos MAG, Moraes Filho AS, Rêgo GRFM, Silva ROL, Sousa RAB, Tchuisseu YP, Silva GEB, Gama MEA. Is splenectomy an option for multiple relapses in a child with visceral leishmaniasis? A case report. Rev Soc Bras Med Trop 2021; 54:e0748-2020. [PMID: 33759927 PMCID: PMC8008903 DOI: 10.1590/0037-8682-0748-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/12/2021] [Indexed: 11/21/2022] Open
Abstract
Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania spp. The recurrence of the disease occurs, in general, in patients with decreased or loss of T-cell function, whether due to the use of corticosteroids, immunosuppressive disease, or another cause. In some cases, splenectomy may be a therapeutic option. However, the effectiveness of splenectomy is not well defined. This report describes the evolution of a pediatric patient with seven recurrences of VL, who relapsed post-surgery after drug therapy and splenectomy.
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Shrestha SB, Pyakurel UR, Khanal M, Upadhyay M, Na-Bangchang K, Muhamad P. Epidemiological situations and control strategies of vector-borne diseases in Nepal during 1998–2016. JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.1108/jhr-10-2018-0124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this paper is to investigate epidemiology and control strategies of the four priority vector-borne diseases (VBDs) in Nepal, i.e. malaria, Kala-azar (visceral leishmaniasis), lymphatic filariasis (LF) and dengue fever/dengue hemorrhagic fever.
Design/methodology/approach
The study was a retrospective design to collect data during 1998–2016 from VBDs endemic districts of Nepal. All data were reviewed and epidemiological information of the four VBDs were analyzed.
Findings
The number of malaria cases during 1998–2016 of the 13 affected districts was declined from 8,498 to 991 cases with no record of deaths since 2012. The number of cases and deaths in the 12 kala-azar (visceral leishmaniasis) affected districts in 1998 was 1,409 and 42 cases, respectively, but was dramatically decreased in 2016 to 213 and 2 cases, respectively. LF cases of the 61 affected districts in 2011, 2014 and 2016 were 28,855, 30,000 and 33,517 cases, respectively. In total, 25 districts achieved elimination target and the remaining are expected to complete the needful cycles by 2018. Dengue incidence of the 31 affected districts during 2006–2015 was under controlled with reported cases of 642, 356 and 136 cases in 2013, 2014 and 2015, respectively, and only one death in 2015. Implementation of control strategies particularly disease management and community peoples’ awareness significantly reduced the cases and deaths of the target VBDs.
Practical implications
The results of this study clearly suggest that the current control strategies have been worked effectively. However, in particular of the VBDs, health education in communities in the endemic areas should be adopted for better community participation in the context of the primary health care approach and increase the effectiveness of disease control.
Originality/value
VBDs, i.e., malaria, kala-azar (visceral leishmaniasis), LF and dengue fever/dengue hemorrhagic fever, are major causes of morbidity and mortality in the least developed countries which include Nepal. Globalization of travel and trading, unplanned urbanization, environmental and climate change are having a significant impact on disease transmission. Therefore, the Ministry of Health of Nepal had brought some changes in strategies based on activities for disease control, vector control, preventive and preparedness for outbreak response. Consequently, the cases and deaths due to malaria, kala-azar (visceral leishmaniasis), lymphatic filaiasis and dengue fever/dengue hemorrhagic fever have been brought down markedly.
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Borsari C, Quotadamo A, Ferrari S, Venturelli A, Cordeiro-da-Silva A, Santarem N, Costi MP. Scaffolds and Biological Targets Avenue to Fight Against Drug Resistance in Leishmaniasis. ANNUAL REPORTS IN MEDICINAL CHEMISTRY 2018. [DOI: 10.1016/bs.armc.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Komitopoulou A, Tzenou T, Baltadakis J, Apostolidis J, Karakasis D, Harhalakis N. Is leishmaniasis an "unusual suspect" of infection in allogeneic transplantation? Transpl Infect Dis 2014; 16:1012-8. [PMID: 25412926 DOI: 10.1111/tid.12316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 08/12/2014] [Accepted: 09/13/2014] [Indexed: 12/20/2022]
Abstract
Leishmaniasis is a disease of the immunocompetent population, more often affecting infants and young children. However, the number of leishmaniasis cases associated with immunosuppression has increased over the last 20 years. The visceral form of the disease, visceral leishmaniasis (VL), is identified as an opportunistic infection in immunosuppressed individuals, occurring mainly after solid organ transplantation, especially in renal transplant recipients. Limited data are available about VL after hematopoietic stem cell transplantation (HSCT). We report the cases of 3 patients with late VL after allogeneic HSCT, and review the literature.
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Affiliation(s)
- A Komitopoulou
- Department of Haematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
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