Cumulative cardiac toxicity of sodium stibogluconate and amphotericin B in treatment of kala-azar.
Kala-azar or visceral leishmaniasis is a disseminated protozoal infection caused by parasites of the genus Leishmania (Leishmania donovani in India). Conventional therapy for visceral leishmaniasis continues to be pentavalent antimony (sodium antimony gluconate [SAG]). Amphotericin B is widely used for SAG-unresponsive cases and sometimes even as a first-line drug, especially in endemic areas. With the conventional regimen of SAG, cardiac toxicity has been reported in 8% to 17% of cases with 5% to 7% of them having fatal toxicity. Cardiac toxicity is uncommon with amphotericin B with only few isolated reports. We report some patients with kala-azar in whom coadministration of SAG and amphotericin B led to arrhythmia and sudden death.
Maheshwari
Anu
A
Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India. dranugulati@gmail.com
Seth
Anju
A
Kaur
Satnam
S
Aneja
Satinder
S
Rath
Bimbadhar
B
Basu
Srikanta
S
Patel
Rakesh
R
Dutta
Ashok Kumar
AK
D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects*; D000967:Antimony Sodium Gluconate / Q000008:administration & dosage / Q000009:adverse effects*; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D017809:Fatal Outcome; D006801:Humans; D007194:India; D007893:Leishmania donovani / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000188:drug therapy*; D008297:Male
D000981:Antiprotozoal Agents; D000666:Amphotericin B; D000967:Antimony Sodium Gluconate