Immunotherapy for parasitic disease

Article Abstract:

Visceral leishmaniasis is an infectious parasitic disease transmitted by the bite of the female sandfly. The disease, which involves fever, weight loss, anemia, enlarged liver and spleen and low white blood cell count, is found all over the world. For over 40 years the standard therapy has been pentavalent antimonial drugs. While a substantial proportion of patients with visceral leishmaniasis are successfully treated with pentavalent antimony, some individuals experience only temporary relief or do not improve at all, even after repeated courses of treatment. These patients are typically seriously ill and need an alternative mode of treatment. An article by Badaro et al. in the January 4, 1990 issue of 'The New England Journal of Medicine' reports on the beneficial effects of a new treatment. Injections of interferon gamma were added to the usual pentavalent antimony medication. The study was certainly justified since new treatments are needed, but it is not clear whether all subjects switched to interferon gamma and pentavalent antimony had been first treated for an adequate amount of time on pentavalent antimony alone to be sure they would not respond to it. Also, two of eight subjects did not improve on interferon gamma but later responded to a third drug, amphotericin B, which may possibly be the most valuable drug of all. Since interferon gamma is an expensive medication, it may be more practical in third world countries to stimulate the immune system to fight leishmaniasis with other, less expensive techniques. More research is needed for development of these approaches. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, editorial

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Bacterial infections in patients with visceral leishmaniasis

Article Abstract:

Visceral leishmaniasis, also known in tropical endemic regions as kala-azar, occurs mainly in children and is associated with disorders that suppress the immune system. Symptoms of the disease include fever, anemia, leukopenia (reduced number of white blood cells) and hepatosplenomegaly (enlargement of the liver and spleen). Microbial infections and bleeding are the most common complications in visceral leishmaniasis, and are the leading causes of death. To determine the incidence of bacterial infection in visceral leishmaniasis and to identify the causative agents, 30 patients hospitalized with the disease were monitored. Sixty percent of the patients developed bacterial infections. The most common sites of infection were the respiratory tract (33 percent), skin (33 percent) and middle ear (17 percent). The most common causative agents were Pseudomonas aeruginosa and Staphylococcus aureus. The most commonly used antibiotics were penicillin G and ampicillin. However, gram-negative bacteria were isolated from more than one third of the cases with bacterial infection, and from all of the patients who died. It is recommended that antimicrobial therapy be started immediately when bacterial infection is suspected in patients with visceral leishmaniasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Demographic aspects, Bacterial infections, Kala-azar, Visceral leishmaniasis

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Treatment of visceral leishmaniasis with pentavalent antimony and interferon gamma

Article Abstract:

Visceral leishmaniasis is an infectious parasitic disease transmitted by the bite of the female sandfly. The disease, which involves fever, anemia, enlarged liver and spleen and low white blood cell count, occurs all over the world. For over 40 years the standard therapy has been pentavalent antimonial drugs. These drugs are not always effective and can also be toxic. Alternative therapies can be toxic as well. A new treatment was evaluated, recombinant human interferon gamma in combination with conventional pentavalent antimonial drugs. The eight patients had had visceral leishmaniasis for an average of 17 months and had not responded to repeated pentavalent antimony therapy. Six of the eight were helped by the combination of interferon gamma and pentavalent antimony given for 10 to 40 days. Two patients showed initial improvement but then required other therapy. Another nine patients with the disease had not been treated previously; eight of them responded well to interferon gamma and pentavalent antimony. This combination regimen appears effective for treating patients with severe visceral leishmaniasis who have not yet been treated or do not respond to pentavalent antimony alone. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antimony

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