Adverse reactions to meglumine antimoniate in Brazilian inpatients with visceral leishmaniases: A case series

Abstract

Leishmaniasis is a group of neglected diseases with complex clinical manifestations and is caused by the protozoa Leishmania infantum in Latin America. Leishmaniasis is a poverty-related disease that is endemic in 65 countries. Visceral leishmaniasis (VL) is the most severe clinical form of leishmaniasis. Brazil is among seven countries that account for 90% of the global cases of VL, which is considered a public health problem due to its wide geographic distribution and high lethality rates. 1,2 These data reflect the magnitude of VL in this region and the need for health surveillance programmes focusing on early diagnosis and the efficacy and safety of drug therapy.HIV (human immunodeficiency virus) coinfection has increased the number of deaths related to VL. 3 Therapeutic options for VL include pentavalent antimony (Sb v ) salts, several formulations of amphotericin B, paromomycin, pentamidine and the oral agent miltefosine. However, these options exhibit variable efficacy and have significant severe adverse drug reactions (ADR) or high costs, such as that for liposomal amphotericin B (L-AmB). 4,5 In Brazil, meglumine antimoniate (MA) is the first-choice drug for VL, despite its high toxicity. 6 Patients taking MA may experience ADR due to the cumulative drug effects. These ADR include important alterations in cardiac, hepatic and renal functions and pancreatitis. In most cases, these ADR are transient and resolve well when recognized and managed at an early stage. These ADR may require temporary suspension, dose adjustment or drug replacement. 7 Such reactions may be severe and can affect patients' quality of life. 8 We report a case series of ADR in hospitalized VL patients treated with MA. | C A S E DE SCRIP TI ONThis is a case series studied at a general hospital in Belo Horizonte, Southeast Brazil. We studied 14 patients with a mean age of Abstract What is known and objectives: Adverse drug reactions (ADR) related to the treatment of visceral leishmaniasis (VL) can cause severe clinical complications. We report a case series of ADR in hospitalized VL patients on meglumine antimoniate (MA). Case description:Seven cases of patients taking MA had at least one objective evidence for suspected ADR, including electrocardiographic, laboratory or clinical alteration.