Abstract
BackgroundVisceral leishmaniasis (VL) is one of the most neglected tropical infectious diseases. It is fatal if left untreated. The objective of this study was to assess the efficacy and safety of 17-day injections of combined regimen of sodium stibogluconate and paromomycin (SSG/PM) in HIV-negative VL patients.MethodsA retrospective analysis of medical records of VL patients treated in the University of Gondar Hospital during period 2012–2019 was carried out.ResultsA total of 2836 patients were treated for VL from 2012 to 2019. Of these 1233 were treated with SSG-PM, and 1000 of them were included in the study. Initial cure was achieved in 922 (92.2%) patients. The frequency of treatment failure, treatment interruptions, default and deaths respectively were 30 (3%), 20 (2%), 13 (1.3%) and 15 (1.5%). Among 280 patients who completed 6-month follow up, the final cure was 93.9% (263/280), 4 (1.4%) relapsed and 13 (4.6%) developed post-kala-azar dermal leishmaniasis (PKDL). The most common adverse events (AEs) were raised liver transaminases (35.1%; 351 patients), injection site pain (29.1%, 291 patients) and raised serum alpha-amylase (29.1%, 291 patients). Factors associated with poor treatment outcomes were sepsis, pneumonia, and adverse events.ConclusionA combination of SSG at 20mg/kg with upper daily maximum dose of 850mg and PM was effective for achieving initial cure at end of treatment and safe for treatment of HIV negative VL patients in northwestern Ethiopia. Our data are consistent with previous reports and confirms effectiveness of SSG/PM treatment regimen in the Eastern African countries. Efficacy at 6-months (93.9%) was estimated on data derived from patients who completed follow up and needs to be interrogated by future studies.
Highlights
Visceral leishmaniasis (VL) is among the most neglected tropical diseases caused by the protozoan parasite of the genus Leishmania
A combination of SSG at 20mg/kg with upper daily maximum dose of 850mg and PM was effective for achieving initial cure at end of treatment and safe for treatment of HIV negative VL patients in northwestern Ethiopia
Our data are consistent with previous reports and confirms effectiveness of sodium stibogluconate and paromomycin (SSG/PM) treatment regimen in the Eastern African countries
Summary
Visceral leishmaniasis (VL) is among the most neglected tropical diseases caused by the protozoan parasite of the genus Leishmania Its transmission occurs through the bite of phlebotomine sand flies other routes of transmission including blood transfusion, intravenous drug use, organ transplantation, and congenital and laboratory accidents are implicated [2]. The annual incidence of VL is approximately 0.2 to 0.4 million. Over 90% of global VL cases occur in six countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil [3]. Visceral leishmaniasis (VL) is one of the most neglected tropical infectious diseases. The objective of this study was to assess the efficacy and safety of 17day injections of combined regimen of sodium stibogluconate and paromomycin (SSG/PM) in HIV-negative VL patients
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