Use of miltefosine in the treatment of visceral leishmaniasis in children at a tertiary care hospital of Karachi.
Existing standard treatment options for visceral leishmaniasis are less than optimal. We report here the use of oral miltefosine in the treatment of two paediatric cases of visceral leishmaniasis at a tertiary care hospital in Karachi, Pakistan. One patient came from Balochistan while the second patient was from Northern Pakistan. Both presented with a prolonged history of fever, massive hepatosplenomegaly, anaemia and thrombocytopenia. Visceral leishmaniasis was diagnosed with bone marrow studies. Amphotericin B was first started in the first patient; however severe hypokalaemia and allergic reaction occurred. Oral miltefosine was then administered. The child showed clinical improvement with regards to signs of leishmania infection but succumbed to a nosocomial infection during the hospital stay. In the second patient, miltefosine was started in the first instance. He showed remarkable clinical improvement. At 2 months follow-up, the child showed adequate weight gain along with successful resolution of hepatosplenomegaly and fever. Miltefosine has the potential to be considered a first line therapy for visceral leishmaniasis in developing countries; however larger studies are warranted to validate the trends observed in this small case series.
Humayun
Khadija Nuzhat
KN
Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Saleem
Taimur
T
Khalid
Umair
U
Jehan
Fyezah
F
Soofi
Sajid
S
D000284:Administration, Oral; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D002648:Child; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007893:Leishmania donovani / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D010154:Pakistan; D010767:Phosphorylcholine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D000981:Antiprotozoal Agents; D010767:Phosphorylcholine; C039128:miltefosine