Cure of post Kala-azar dermal leishmaniasis with paromomycin/sodium stibogluconate combination: a proof of concept

Younis BM, Mohammed HAA, Dafalla MMM, Adam AOA, Elamin MY, Musa AM, El-Hassan AM, Eltahir Awad Gasim Khalil

Abstract


Background: Post kala-azar dermal leishmaniasis (PKDL) is  a  recognized  dermatologic  complication  of  successfully  treated  visceral  leishmaniasis  (VL). PKDL lesions are suspected to be important reservoirs for VL transmission in Sudan. Prolonged treatment schedules, feeling of general well-being and the social stigmata of PKDL prevent most patients seeking treatment. The mainstay of treatment is cardiotoxic sodium stibogluconate (SSG) for 60-120 days. Recently, liposomal amphotericin B (Ambisome®) and immunochemotherapy gave promising results. Ambisome® is expensive and difficult to prepare under field conditions. Paromomycin/SSG combination has been shown to be safe, efficacious and can save time in VL treatment. This study aims to prove that Paromomycin/SSG combination can cure and reduce PKDL treatment duration.

Methods:We are reporting nine cases of patients with PKDL lesions of ≥6 months duration who were diagnosed by clinical signs, histopathological/immunohistochemical and PCR.

Results: Patients’ mean age was 11.7 ± 4.3 years. A third of the patients (3/9; 33.3%) who failed previous SSG treatment of 2-3 months duration responded completely to 40 days of paromomycin/SSG combination. The majority of patients (5/9; 55.6%) responded completely to 30 days of the combination. One patient (1/9; 11.1%) relapsed following 30 days paromomycin/SSG combination.

Conclusion:It was concluded that paromomycin/SSG combination for 30 days is time-saving, safe and efficacious for PKDL treatment.

 


Keywords


Short course, Paromomycin/sodium stibogluconate combination, PKDL

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References


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