title: [Resistance of Leishmania infantum to Glucantime: risk factors and therapeutic management].
abstract: BACKGROUND
  Resistance to antimonial drugs is rarely observed in immunocompetent patients.
  
  
  METHODS
  A 1-year-old girl was admitted suffering from persistent fever. A diagnosis of visceral leishmaniasis was made. The patient was given two courses of meglumine antimoniate (Glucantime) (60 mg/kg/d for 15 days) and one course of 12 injections of pentamidine (4 mg/kg). She relapsed 8 months later and failed to respond to Glucantime. Immunological tests performed during the relapse showed a suppression of the T cell response to Leishmania antigen and no production of interferon gamma. The patient was then successfully given liposomal amphotericin B (3 mg/kg/d for 10 days). She was asymptomatic 9 months later and had acquired specific cellular immunity against Leishmania.
  
  
  CONCLUSIONS
  Deficient cell-mediated immunity and interferon gamma production are some factors responsible for decreased sensitivity to antimonial drugs. The WHO recommendations treating visceral leishmaniasis with prolonged administration of Glucantime may prevent relapses. Liposomal amphotericin B could be an alternative treatment.
authors: Service de pédiatrie, hôpital de La Timone, Marseille, France.
authors: R
authors: R
authors: Piarroux
authors: J M
authors: JM
authors: Garnier
authors: F
authors: F
authors: Gambarelli
authors: H
authors: H
authors: Dumon
authors: S
authors: S
authors: Kaplanski
authors: D
authors: D
authors: Unal
mesh_terms: D000818:Animals; D000981:Antiprotozoal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D007223:Infant; D007371:Interferon-gamma / Q000172:deficiency; D018314:Leishmania infantum / Q000187:drug effects*; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism; D008536:Meglumine / Q000494:pharmacology* / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D009942:Organometallic Compounds / Q000494:pharmacology* / Q000627:therapeutic use; D010419:Pentamidine / Q000008:administration & dosage; D012008:Recurrence
chemical_list: D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D010419:Pentamidine; D008536:Meglumine; D000077485:Meglumine Antimoniate; D007371:Interferon-gamma
vernacular_title: Résistance de Leishmania infantum au Glucantime: circonstances de survenue et prise en charge thérapeutique.