Electrocardiogram changes due to sodium stibogluconate treatment of kala-azar
DOI:
https://doi.org/10.18203/2320-6012.ijrms20230335Keywords:
Visceral Leishmaniasis, Electrocardiogram, ST change, ArrhythmiaAbstract
Background: Kala-azar [visceral leishmaniasis (VL)] is caused by the protozoon Leishmania donovani complex. Without adequate treatment, most patients with clinical VL die due to secondary infections. Pentavalent antimonial compounds are commercially available as sodium stibogluconate and meglumine antimoniate. Sodium stibogluconate remains the mainstay of treatment in most parts of the world. The aim of the study was to evaluate the serious adverse effects of sodium stibogluconate in the treatment of kala-azar (VL).
Methods: The study was carried out in the medicine department of North Bengal Medical College Hospital, Sirajganj during the period of June 2021 to December 2021. It was a descriptive cross-sectional study with a sample size of 30. Complete history taking and physical examination were done and recorded in a case record form. At least 7 electrocardiograms (ECGs) were done (1 before treatment, 5 during treatment weekly intervals, and 1 after completion of treatment).
Results: In ECG, the following changes were noted (the rhythm, T wave amplitude, ST segment, and QTc interval). Out of 30 patients, 19 patients (63.33%) developed abnormalities in ECG. Among them, 14 patients (46.67%) developed prolongation of QTc interval, 6 patients developed T wave inversion, and 1 patient developed transient 1st-degree heart block. No patients developed symptomatic arrhythmia.
Conclusions: Kala-azar is prevalent among the poor in Bangladesh and can be fatal without treatment. Sodium stibogluconate has been associated with cardiological adverse effects, but it can be used safely with proper monitoring.
References
Raiston SH, Penman ID, Strachan MWJ, Hobson RP. Infectious disease in Davidson's Principle and Practice of Medicine. 23rd ed. Philadelphia: Elsevier; 2018: 281-282.
Dedet JP, Pratlong F. Leishmaniasis in Manson's Tropical Diseases. 21st ed. Philadelphia: Saunders Elsevier; 2003: 1339-1364.
Rashid KM, Rahman M, Hyder S. Special Health Problems and Programmes. Textbook of Community Medicine and Public Health. 4th ed. Dhaka: RHM; 2004: 325-330.
Todd WTA, Lockwood DNJ, Sunder S. Infectious disease in Davidson's Principle and Practice of Medicine. 20th ed. Philadelphia: Elsevier; 2006: 283-376.
Sunder S, Sinha PR, Agrawal NK, Shrivastar R, Rainey PM, Berman JD, et al. A cluster of cases of severe cardiotoxicity among Kala-azar patients treated with antimony gluconate. American J Trop Med Hygiene. 1998;59(1):139-43.
Rang HP, Dale MM, Ritter JM, Moore PK. Harmful effects of drugs. Pharmacology. 5th ed. London, UK: Churchill Livingstone; 2003: 724-737.
Kiri R, Sati ME. Observations on the use of sodium antimony gluconate in the treatment of Kala-azar. Anna Trop Med Parasitol. 1947;41:14-21.
Chulay JD, Spencer HC, Mugambi M. Electrocardiographic changes during treatment of leishmaniasis with pentavalent antimony (sodium stibogluconate). Am J Trop Med Hyg. 1985;34(4):702-9.
Aronson NE, Wortmann GW, Johnson SC, Jackson JE, Gasser RA, Magill AJ, et al. Safety and efficacy of intravenous sodium stibogluconate in the treatment of leishmaniasis: recent U.S. military experience. Clin Infect Dis. 1998;27(6):1457-64.
Chappuis F, Sundar S, Hailu A, Ghalib H, Rijal S, Peeling RW, et al. Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol. 2007;5(11):873-82.
Yap YG, Camm AJ. Drug induced QT prolongation and torsades de pointes. Heart. 2003;89(11):1363-72.
Lawn SD, Armstrong M, Chilton D, Whitty CJ. Electrocardiographic and biochemical adverse effects of sodium stibogluconate during treatment of cutaneous and mucosal leishmaniasis among returned travellers. Trans R Soc Trop Med Hyg. 2006;100(3):264-9.
