Document 0398
 DOCN  M9440398
 TI    [Visceral leishmaniasis resistant to conventional treatments: value of
       amphotericin B]
 DT    9404
 AU    Bernard E; Quaranta JF; Durant J; Le Fichoux Y; Dellamonica P; Maladies
       Infectieuses et Tropicales, Hopital de l'Archet, Nice,; France.
 SO    Pathol Biol (Paris). 1993 Oct;41(8 Pt 2):817-9. Unique Identifier :
       AIDSLINE MED/94143078
 AB    The reference treatment in visceral leishmaniasis is administration of
       antimonial compounds (Pentostam, Glucantime). Primary and secondary
       failures have been reported and may involve several mechanisms resulting
       in alterations in the T-cell-dependent response, particularly in
       HIV-positive patients. Alternative agents proposed for use as
       single-drug therapy or in combination with other drugs include Lomidine,
       which carries a high risk of toxicity, allopurinol, cytokines (IL-2 and
       interferon gamma), and amphotericin B. Amphotericin B, in addition to
       effects on the metabolism of sterols in the wall of the protozoan,
       induces macrophage activation. This article illustrates the difficulty
       of treatment of visceral leishmaniasis by reporting the case of an
       immunocompetent 36-year-old patient whose bone marrow cultures remained
       positive after successive treatment, over 48 months, with two courses of
       Glucantime (60 mg/kg/day for 15 days), one course of allopurinol (10
       mg/kg/4 weeks), two courses of Glucantime in combination with interferon
       gamma, splenectomy, and one course of Pentostam (20 mg/kg/4 weeks). Bone
       marrow cultures became negative after administration of amphotericin B
       (1 mg/kg every 48 hours for 8 weeks). Cytokine studies disclosed
       defective production of IL-2, IL-1 beta, and IFN gamma. Amphotericin B
       seems to be a valuable alternative when conventional treatment fails.
       The liposomal form is especially promising.
 DE    Adult  Amphotericin B/*THERAPEUTIC USE  Antigens, CD3/IMMUNOLOGY  Case
       Report  English Abstract  Human  Interferon Type II/DEFICIENCY
       Interleukin-1/DEFICIENCY  Interleukin-2/DEFICIENCY  Leishmaniasis,
       Visceral/*DRUG THERAPY/IMMUNOLOGY  Male  JOURNAL ARTICLE

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