[Resistance of Leishmania infantum to Glucantime: risk factors and therapeutic management].
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.
Piarroux
R
R
Service de pédiatrie, hôpital de La Timone, Marseille, France.
Garnier
J M
JM
Gambarelli
F
F
Dumon
H
H
Kaplanski
S
S
Unal
D
D
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
D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D010419:Pentamidine; D008536:Meglumine; D000077485:Meglumine Antimoniate; D007371:Interferon-gamma
Résistance de Leishmania infantum au Glucantime: circonstances de survenue et prise en charge thérapeutique.