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Unresponsiveness to AmBisome in some Sudanese patients with kala-azar.

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dc.contributor Medécins Sans Frontières, Plantage Middenlaan 14, 1018 DD Amsterdam, The Netherlands.
dc.creator Mueller, M
dc.creator Ritmeijer, K
dc.creator Balasegaram, M
dc.creator Koummuki, Y
dc.creator Santana, M R
dc.creator Davidson, R N
dc.date 2007-01
dc.date.accessioned 2017-01-31T07:09:42Z
dc.date.available 2017-01-31T07:09:42Z
dc.identifier Unresponsiveness to AmBisome in some Sudanese patients with kala-azar. 2007, 101 (1):19-24 Trans. R. Soc. Trop. Med. Hyg.
dc.identifier 0035-9203
dc.identifier 16730363
dc.identifier 10.1016/j.trstmh.2006.02.005
dc.identifier http://hdl.handle.net/10144/18262
dc.identifier http://fieldresearch.msf.org/msf/handle/10144/18262
dc.identifier Transactions of the Royal Society of Tropical Medicine and Hygiene
dc.identifier.uri http://dspace.mediu.edu.my:8181/xmlui/handle/10144/18262
dc.description In Sudan, two treatments are currently registered for visceral leishmaniasis: sodium stibogluconate (SSG) as first line and liposomal amphotericin B (AmBisome) as second line. We present 64 patients (52 relapse cases to SSG, 12 new but complicated cases) treated with AmBisome in eastern Sudan. AmBisome was administered at 2.5-8.2mg/kg (15-49mg/kg in total) per dose six times (days 1, 2, 3, 5, 10, 15) as an intravenous infusion. We measured outcome according to clinical response and parasitological clearance (lymph node aspiration). Patient outcomes fell into three groups: group 1, clinical responders (cured) with a negative test of cure (n=35); group 2, clinical responders with a positive test of cure (n=19); group 3, clinical non-responders (failures) with a positive test of cure (n=10). Of the 10 failures, six were already relapse cases. All of group 3, and 15 from group 2, were also treated with additional SSG (20mg/kg intramuscularly daily for 30-50 d) with resulting clinical and parasitological improvement. Parasite persistence and clinical failure were associated with a higher parasite density on admission (P<0.002) and underlying immunosuppressive disease: tuberculosis (three cases) or HIV (two cases). Because AmBisome monotherapy may fail in Sudan, a combination of AmBisome and SSG is recommended for relapse cases.
dc.language en
dc.publisher Elsevier
dc.relation http://www.sciencedirect.com/science/journal/00359203
dc.rights Archived on this site with the kind permission of Elsevier Ltd. and the Royal Society of Tropical Medicine and Hygiene, http://www.rstmh.org/transactions.asp
dc.title Unresponsiveness to AmBisome in some Sudanese patients with kala-azar.

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