Immunochemotherapy of persistent post-kala-azar dermal leishmaniasis: a novel approach to treatment
| Autor: | Sara Hamad Hassab Elgawi, Eltahir A G Khalil, Sassan Noazin, Abd Elgadir Mohamed Yousif Elkadaru, Ahmed M. Elhassan, Mona Hussein Aboud, H.W. Ghalib, Ahmed Eleojo Musa, Fawzi Abd Elrahim Mahgoub, Farroukh Modabber |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Sodium stibogluconate medicine.medical_treatment Statistics as Topic Antiprotozoal Agents Gastroenterology Sudan Interferon-gamma Double-Blind Method Internal medicine parasitic diseases Medicine Humans Vaccines Combined Adverse effect Child Leishmaniasis Vaccines Post-kala-azar dermal leishmaniasis Chemotherapy business.industry Public Health Environmental and Occupational Health Leishmaniasis General Medicine Middle Aged medicine.disease Vaccine efficacy Interleukin-10 Regimen Infectious Diseases Visceral leishmaniasis Treatment Outcome Antimony Sodium Gluconate Immunology BCG Vaccine Leishmaniasis Visceral Parasitology Female business medicine.drug |
| Zdroj: | Transactions of the Royal Society of Tropical Medicine and Hygiene. 102(1) |
| ISSN: | 0035-9203 |
| Popis: | Post-kala-azar dermal leishmaniasis (PKDL) is a recognized dermatosis that follows successful treatment of visceral leishmaniasis in the Sudan. This randomized and double-blind study aimed to assess safety, immunogenicity and curative potentials of a novel immunochemotherapy regimen in patients with persistent PKDL. Following informed consent, 30 patients were randomized to receive alum-precipitated autoclaved Leishmania major (Alum/ALM) vaccine+Bacille Calmette-Guerin (BCG) and sodium stibogluconate (SSG) or vaccine diluent and SSG. The SSG+Alum/ALM+BCG proved safe with minimal local adverse events. In the SSG+vaccine group, 87% of the patients were cured by day 60 compared with 53% in the SSG alone group (SSG+vaccine efficacy=71%, 95% CI for risk ratio 0.7-1.16). On day 90 of follow-up there were two relapses in the SSG alone arm and none in the SSG+vaccine arm. Pre-treatment cytokines showed high IFN-gamma or high IFN-gamma/IL-10 levels and leishmanin skin test (LST) non-reactivity, while healing/clinical improvement were associated with LST reactivity and low IFN-gamma levels in both study groups (P=0.004). In conclusion, SSG+Alum/ALM+BCG is safe and immunogenic with significant healing potentials in persistent PKDL lesions. Immunochemotherapy probably augmented IFN-gamma production, which induced healing. Leishmanin skin reactivity is a good surrogate marker of cure in persistent PKDL lesions. |
| Databáze: | OpenAIRE |
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