Visceral leishmaniasis-hepatitis B/C coinfections: a rising necessity to triage patients for treatment

Abstract

BACKGROUND AND OBJECTIVESVisceral leishmaniasis (VL) is a life-threatening infection caused by Leishmania species. In Sudan, VL is caused by L donovani. Most drugs used to treat VL, especially pentavalent antimony compounds (sodium stibogluconate, SSG), are potentially hepatotoxic. A number of fatal catastrophes happened because patients with VL-hepatitis B/C coinfection were indiscriminately treated with SSG in settings where VL and viral hepatitis coexist. This study aimed to study biochemical and hematological parameters of patients with VL-hepatitis B/C coinfections with the aim to modify treatment protocols to reduce coinfection-added morbidity and mortality.DESIGN AND SETTINGSThis was a prospective analytical, hospital-based, and case-controlled study. The study was done at Kassab Hospital and Professor Elhassan Centre for tropical medicine during the period of February 2008 to April 2013.MATERIALS AND METHODSFollowing informed consent by the participants, 78 parasitologically confirmed VL patients with either hepatitis B or C or both and 528 sex- and age-unmatched VL patients without hepatitis B/C coinfection (control group) were enrolled sequentially. Diagnosis of hepatitis B or C was made using immunochromatographic test kits and confirmed by an enzyme-linked immunosorbent assay.RESULTSVL patients with hepatitis B/C coinfections had significantly increased levels of AST, ALT, and total bilirubin compared to the control group (P=.0001 for all), with significantly decreased levels of albumin and platelets counts (P=.0029 for both).CONCLUSIONVL-hepatitis B/C coinfections are an emerging entity that needs anti-leishmanial treatment modification. Alternative treatments like paromomycin and amphotericin B (AmBisome) could be reserved for these patients.

Case Report: FDG-PET/CT findings in co-infection of visceral leishmaniasis and chronic hepatitis B

“…Moreover, a prospective study showed significant increases in AST (>60 IU/L) and ALT (>61 IU/L), as well as total bilirubin (1.1 mg/dl), with significantly decreased levels of albumin (2.6 g/dl) and platelet count (105 * 10 3 /μl) in the co-infection of VL and hepatitis B cases. Similar to the cases described above, the serological profiles of our patients are consistent with these features, which indicated persistent liver damage ( Abubakr et al., 2014 ). Furthermore, the treatment of VL with sodium stibogluconate (SSG) is a standardized and antimonial drug, which can cause a risk of hepatotoxicity ( Mengstie et al., 2021 ).…”

Severe Kala-azar and seric level of IL-6: case reports

“…In addition, they reduce albumin levels and increase in globulins, contributing to the formation of lower limb edema, a clinical manifestation reported in all three cases. The transaminases level of the coinfected Leishmania/HBV patient was below 100 IU indicating probably a reduced liver function 10 .…”

Leishmaniasis immunopathology—impact on design and use of vaccines, diagnostics and drugs

“…With the more profound immunosuppression associated with HIV-VL co-infections, the standard drugs become significantly less effective and only co-administrations have been shown to improve treatment [112]. The low efficacy of three of the drugs (liposomal amphotericin B, paromomycin and miltefosine) in eastern African VL [113,114] that are so effective in the Indian subcontinent, has not been explained. Clinical isolates from both regions show similar susceptibility to these drugs within standard in vitro assays, so the clear implication is that host factors (immunology, pathology, pharmacokinetics [PKs]) are the responsible for this difference.…”