Epidemiological, clinical & pharmacological study of antimony-resistant visceral leishmaniasis in Bihar, India.

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dc.contributor.authorThakur, C Pen_US
dc.contributor.authorNarayan, Sen_US
dc.contributor.authorRanjan, Aen_US
dc.date.accessioned2004-09-19en_US
dc.date.accessioned2009-05-27T08:30:24Z
dc.date.available2004-09-19en_US
dc.date.available2009-05-27T08:30:24Z
dc.date.issued2004-09-19en_US
dc.description.abstractBACKGROUND & OBJECTIVES: Sodium antimony gluconate (SAG) is reported to be losing its efficacy in Bihar as a first line drug for treatment of visceral leishmaniasis (VL). Concerned with the increasing incidence of antimony-resistant VL patients in Bihar, we undertook an epidemiological, clinical and pharmacological study to formulate a scientific basis for choosing a suitable first line drug for VL. METHODS: Consecutive, fresh and parasitologically confirmed patients of VL from different geographical areas of Bihar were considered for inclusion in the study. Parasites isolated from patients were tested in vitro to assess their response to sodium antimony gluconate (SAG) to 20 microg/ml, response to 20 mg/kg of SAG for 5 days in experimentally induced VL in BALB/c mice from those isolates, and response to SAG in patients treated with SAG for 28 days. Similarly response in culture (1 microg/ml) to amphotericin B (AMB) of all 282 isolates, (1 mg/kg body wt for 20 days) in patients and infected BALB/c mice (1 mg/kg body wt for 5 days) was determined. Antimony levels of plasma were determined at 2, 8 and 24 h after intramuscular injection of SAG. Patients unwilling for SAG treatment or relapsed after SAG treatment and withdrawn from SAG group because of toxicity were treated with AMB. Plasma antimony levels were estimated by atomic absorption spectrometer. RESULTS: Though antimony sensitive and resistant patient were distributed in all 14 districts of Bihar studied, there was a significant variation from district to district. Of the 123 patients included in the SAG treatment group, 19 were withdrawn due to development of toxicity and 2 died; 178 patients were treated with AMB. No patient in AMB group developed any toxicity or died. Only 47 (46%) of 102 patients, 106 (37.6%) of 282 infected macrophages, 90 (52.9%) of 170 experimental infections were cured with SAG. Mc Nemar's test on paired comparisons showed statistical significance difference (P<0.01) between infected macrophage and experimental infection. AMB cured all patients, infected mice and cleared parasites from all isolates. INTERPRETATION & CONCLUSION: Antimony resistant strains of L. donovani were wide spread over different geographical areas in Bihar. SAG cured lesser percentage of VL cases clinically compared to AMB and should be replaced by AMB as a first line drug.en_US
dc.description.affiliationBalaji Utthan Sansthan & Rajendra Memorial Research Institute of Medical Sciences, Patna, India. cpthakur@sancharnet.inen_US
dc.identifier.citationThakur CP, Narayan S, Ranjan A. Epidemiological, clinical & pharmacological study of antimony-resistant visceral leishmaniasis in Bihar, India. Indian Journal of Medical Research. 2004 Sep; 120(3): 166-72en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/24685
dc.language.isoengen_US
dc.source.urihttps://icmr.nic.in/ijmr/ijmr.htmen_US
dc.subject.meshAdulten_US
dc.subject.meshAmphotericin B --therapeutic useen_US
dc.subject.meshAnalysis of Varianceen_US
dc.subject.meshAnimalsen_US
dc.subject.meshAntimony --blooden_US
dc.subject.meshAntimony Sodium Gluconate --therapeutic useen_US
dc.subject.meshAntiprotozoal Agents --therapeutic useen_US
dc.subject.meshChilden_US
dc.subject.meshDrug Resistance --physiologyen_US
dc.subject.meshHumansen_US
dc.subject.meshIndia --epidemiologyen_US
dc.subject.meshLeishmaniasis, Visceral --drug therapyen_US
dc.subject.meshMaleen_US
dc.subject.meshMiceen_US
dc.subject.meshMice, Inbred BALB Cen_US
dc.subject.meshSpectrophotometry, Atomicen_US
dc.titleEpidemiological, clinical & pharmacological study of antimony-resistant visceral leishmaniasis in Bihar, India.en_US
dc.typeComparative Studyen_US
dc.typeJournal Articleen_US
dc.typeResearch Support, Non-U.S. Gov'ten_US
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