title: Study of parasite kinetics with antileishmanial drugs using real-time quantitative PCR in Indian visceral leishmaniasis.
abstract: OBJECTIVE
  This study describes parasite kinetics in the blood of visceral leishmaniasis patients treated with liposomal amphotericin B (L-AmB) or a preformed fat emulsion of amphotericin B (ApL) using real-time quantitative PCR (qPCR).
  
  
  METHODS
  Forty-six patients were treated with a single dose (15 mg/kg of body weight) of either L-AmB (n = 13) or ApL (n = 33). qPCR was used to estimate parasite kinetics by detection of Leishmania donovani DNA using kinetoplast DNA-specific primers in peripheral blood samples using an absolute quantification method.
  
  
  RESULTS
  The mean parasite load decreased from baseline (day 0) values of 894.07 and 980.48 to 71.72 and 211.52 parasite genomes/mL at day 7 in L-AmB and ApL groups, respectively, and at day 30 these further declined to 8.30 and 133.98 parasite genomes/mL, respectively. At day 30 post-treatment evaluation, the decline in parasite load was significantly greater (P = 0.024) with L-AmB compared with ApL. Four of 33 patients in the ApL group failed treatment (1 primary failure and 3 relapses) with the presence of parasites, whereas all patients in the L-AmB group were cured at 6 month follow-up.
  
  
  CONCLUSIONS
  qPCR can be a tool to measure parasite dynamics accurately and provide a marker to measure the efficacy of various drugs. It can be used as a test of cure, allowing us to do away with invasive and risky methods such as splenic or bone marrow aspiration.
authors: Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, UP, India.
authors: Medhavi
authors: M
authors: Sudarshan
authors: Jason L
authors: JL
authors: Weirather
authors: Mary E
authors: ME
authors: Wilson
authors: Shyam
authors: S
authors: Sundar
references: J Clin Microbiol. 1998 Oct;36(10):2877-81
references: 9738037
references: Trends Parasitol. 2002 Aug 1;18(8):338
references: 12377276
references: Am J Trop Med Hyg. 1983 May;32(3):475-9
references: 6859397
references: Am J Trop Med Hyg. 2006 Nov;75(5):858-63
references: 17123977
references: Vet Parasitol. 2006 Apr 30;137(3-4):214-21
references: 16473467
references: Trans R Soc Trop Med Hyg. 2004 Jan;98(1):12-7
references: 14702834
references: J Clin Microbiol. 2004 Mar;42(3):1214-9
references: 15004078
references: J Clin Microbiol. 2010 May;48(5):1932-4
references: 20335419
references: J Clin Microbiol. 2004 Nov;42(11):5249-55
references: 15528722
references: Adv Parasitol. 2006;61:223-74
references: 16735166
references: Trop Med Int Health. 2008 Jan;13(1):2-5
references: 18290995
references: J Clin Microbiol. 2003 Nov;41(11):5080-4
references: 14605142
references: J Clin Microbiol. 2002 May;40(5):1666-9
references: 11980939
references: PLoS Negl Trop Dis. 2009;3(4):e419
references: 19381287
references: Acta Trop. 2004 Nov-Dec;92(3):279-83
references: 15533299
references: Trends Parasitol. 2003 Feb;19(2):60-3
references: 12586469
references: Am J Trop Med Hyg. 2009 Dec;81(6):1004-6
references: 19996428
references: Indian J Med Res. 2006 Mar;123(3):345-52
references: 16778315
references: Trans R Soc Trop Med Hyg. 2008 Sep;102(9):875-82
references: 18501935
references: Diagn Microbiol Infect Dis. 2008 May;61(1):23-30
references: 18255247
references: Trop Med Int Health. 2007 Feb;12(2):274-83
references: 17300636
references: Ann N Y Acad Sci. 2004 Oct;1026:139-43
references: 15604481