Pentamidine as secondary prophylaxis for visceral leishmaniasis in the immunocompromised host: report of four cases

Abstract

SummaryWe report a retrospective and descriptive study of four immunocompromised patients (three with HIV-1 and one with idiopathic CD4+-lymphopenia) with relapsing visceral leishmaniasis seen at the Hospital for Tropical Diseases, London, in whom pentamidine was used as secondary prophylaxis to prevent relapse. Patients experienced between one and four relapses before commencing prophylaxis with subsequent relapse-free periods ranging from 5 to 98 months. Based on these observational data, we recommend large trials to investigate the efficacy of pentamidine over other agents in preventing relapse of VL in the immunocompromised patient.

Comparative modeling of HGPRT enzyme of L. donovani and binding affinities of different analogs of GMP

“…The combination regimen of intravenous pentamidine and oral fluconazole successfully cured the relapse of leishmaniasis [36]. Pentamidine was used as a secondary prophylactic agent to prevent relapse in four immunocompromised patients (three with HIV-1 and one with idiopathic CD4+-lymphopenia) with relapsing visceral leishmaniasis at the Hospital for Tropical Diseases, London [37]. The dock scores (57.342 and 61.144) of miltefosine and paromomycin with HGPRT show that these two compounds have lower affinities for HGPRT than do pentamidine and 1,3-dinitroadamantane.…”

Traitement des leishmanioses en France : proposition d’un référentiel consensuel

“…La pentamidine, efficace dans la LV uniquement à fortes doses, n'est plus utilisée du fait de sa toxicité. À faibles doses, elle reste une option raisonnable dans certaines formes de LC [25] ou en prophylaxie secondaire de la LV de l'immunodéprimé [26]. Les médicaments de référence et les nouveaux anti-leishmaniens, en monothérapie ou en association, ont été évalués par de nombreux essais comparatifs prospectifs randomisés dans la leishmaniose viscérale à L. donovani [27,28].…”

Visceral leishmaniasis complicating idiopathic CD4+ T-cell lymphocytopenia: 2 case reports

“…It is a rare condition defined as a CD4 + T cell count persistently <300 cells/μl in the absence of known secondary causes of lymphopenia, such as HIV infection [3]. VL infection in individuals with ICL is a little-reported clinical entity [4, 5, 6] and here we report in detail our experiences of 2 such patients from the Hospital for Tropical Diseases (HTD). The cases discussed here add an important clinical perspective to the immunological models.…”

“…Patients with VL and any form of immunodeficiency, such as ICL or immunosuppressive therapy, must be monitored closely for signs of relapse and may benefit from secondary prophylaxis, which has been found to be effective in preventing relapse in immunocompromised patients [4]. IFNγ therapy has had some success in treatment of other infections in the context of ICL and so may have a future therapeutic role in the management of VL infection in patients with ICL [13, 14].…”