Mucocutaneous Leishmaniasis in a Pregnant Immigrant

Briggs, Neima; Weinhammer, Annika; Ahuja, Chaarushi; Baker, Catherine; Palacios, Carlo Foppiano; Lee, Emily; O'Grady, Niamh; Singanamala, Santhi; Singh, Katelyn; Bandaranayake, Thilinie; Cohen, Jeffrey M.; Damsky, William; Davis, Matthew W.; Mejia, Rojelio; Nelson, Caroline A.; Topal, Jeffrey; Azar, Marwan M.

doi:10.1093/ofid/ofac360

Cited by 3 publications

(8 citation statements)

References 13 publications

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“…At the time of our review, only one publication discussed the use of a dosing weight for LAmB which was used for treatment of pulmonary histoplasmosis in pregnancy 29,43 . No cases were found describing dosing weight of LAmB to treat MCL in pregnancy.…”

Section: Resultsmentioning

confidence: 99%

“…No case reports were found for the treatment of MCL during pregnancy with LAmB at the time of this systematic review. The publication of the case report described in this review represents the first case in the literature 29 . Because of this, a unique dosing strategy was designed for treatment of our patient.…”

Section: Discussionmentioning

confidence: 98%

“…During the treatment course, no adverse events occurred. Potassium and magnesium were repleted per standard of care during the inpatient portion of the treatment course 29 …”

Section: Case Reportmentioning

confidence: 99%

“…Although this agent is considered the systemic treatment option for MCL during pregnancy, common adverse effects such as renal toxicity, electrolyte imbalances, and infusion‐related reactions limit its use. Lipid‐formulated amphotericin B (AmB) preparations have reduced renal toxicity and infusion‐related reactions compared to conventional AmB while maintaining the same effectiveness 22,26–29 …”

Section: Introductionmentioning

confidence: 99%

“…Lipid-formulated amphotericin B (AmB) preparations have reduced renal toxicity and infusion-related reactions compared to conventional AmB while maintaining the same effectiveness. 22,[26][27][28][29] Significant gaps remain in knowledge of AmB pharmacokinetics and pharmacodynamics in special populations including neonates, children, pregnant, and obese patients. 30 The clinical dosing of medications is typically based on data from studies performed in men and nonpregnant women and does not account for the physiologic differences specific to pregnant women.…”

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confidence: 99%

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Dosing implications for liposomal amphotericin B in pregnancy

et al. 2023

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Liposomal amphotericin B (LAmB) is used in the treatment of opportunistic fungal and parasitic infections, including leishmaniasis. Given its lack of known teratogenicity in pregnancy, LAmB is a preferred agent for treatment for these patients. However, significant gaps remain in determining optimal dosing regimens for LAmB in pregnancy. We describe the use of LAmB for a pregnant patient with mucocutaneous leishmaniasis (MCL) using a dosing strategy of 5 mg/kg/day for days 1–7 using ideal body weight followed by 4 mg/kg weekly using adjusted body weight. We reviewed the literature for LAmB dosing strategies, particularly dosing weight, in pregnancy. Of the 143 cases identified in 17 studies, only one reported a dosing weight, in which ideal body weight was used. Five Infectious Diseases Society of America guidelines in total discussed the use of amphotericin B in pregnancy but no guidelines included recommendations for dosing weight. This review describes our experience in using ideal body weight for dosing LAmB in pregnancy for the treatment of MCL. Use of ideal body weight may minimize risk of adverse effects to the fetus compared to the use of total body weight while maintaining efficacy for treatment of MCL in pregnancy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

“…During the treatment course, no adverse events occurred. Potassium and magnesium were repleted per standard of care during the inpatient portion of the treatment course 29 …”

Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Dosing implications for liposomal amphotericin B in pregnancy

et al. 2023

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Drugs and nanoformulations for the management of Leishmania infection: a patent and literature review (2015-2022)

Verdan

Taveira

Lima

et al. 2023

Expert Opinion on Therapeutic Patents

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Windows into leishmaniasis epidemiology in the United States: September 2021 through August 2022

Truong,

Crawford,

Wang-McGuire

et al. 2023

Preprint

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Leishmaniasis is a rare disease in the United States, with an estimated annual incidence of dozens of cases occurring primarily in travelers, migrants, and military personnel. True disease incidence is unknown, since leishmaniasis is not a nationally notifiable condition. Here, we describe the results of molecular leishmaniasis over a 1-year interval (September 2021 to August 2022) when our laboratory served as the primary national reference laboratory for molecular diagnosis of civilian leishmaniasis. We tested 218 specimens submitted from 36 states yielding 94/186 (50.5%) positive cases with species or species complex-level identification and 18 novel mini-exon alleles. Most species belonged to subgenus Viannia (75.6%) and associated with cutaneous or mucocutaneous disease. Cases were associated with recent travel (18.1%), travel timing unspecified (7.4%), migration (7.4%), remote travel (2.1%), military (1.1%), or unknown history (63.8%). These data illustrate the clinical utility of molecular testing for leishmaniasis and provide unique insight into disease epidemiology.

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Mucocutaneous Leishmaniasis in a Pregnant Immigrant

Cited by 3 publications

References 13 publications

Dosing implications for liposomal amphotericin B in pregnancy

Dosing implications for liposomal amphotericin B in pregnancy

Drugs and nanoformulations for the management of Leishmania infection: a patent and literature review (2015-2022)

Windows into leishmaniasis epidemiology in the United States: September 2021 through August 2022

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