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Visceral Leishmaniasis

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Drug Resistance in Leishmania Parasites

Summary

Pentavalent antimonials (SbV) have been the treatment of choice for leishmaniasis since 75 years. In the early 1980s, it was realized that a significant subset of patients with visceral leishmaniasis were not responding to SbV in the State of Bihar, India. Revised recommendations using tenfold more drug provided a transient reprieve; however, a large proportion of patients in India, and to some extent in Nepal, remained unresponsive to SbV. Besides this, in vitro studies have suggested emergence of SbV refractory strains in India. Attempts to find a marker of unresponsiveness have failed so far. Alternative therapeutic options include conventional Amphotericin-B or its lipid formulations, oral Miltefosine, and paromomycin. Though injectable, the most affordable alternative is likely to be paromomycin, whereas a single dose of liposomal Amphotericin-B (dose 10 mg/kg) is as effective with cure rate of 96%. If these scarce antileishmanial drugs are to be protected from going down the lane of SbV, multidrug, short-course, affordable treatment of VL should be implemented with access to all patients.

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Authors and Affiliations

  1. Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, Uttar Pradesh, India

    Shyam Sundar & Jaya Chakravarty

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  1. Shyam Sundar
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  2. Jaya Chakravarty
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Correspondence to Shyam Sundar .

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Editors and Affiliations

  1. Fac. Medicina, Instituto de Medicina Experimental, Universidad Central de Venezuela, Caracas, 1062, Venezuela

    Alicia Ponte-Sucre

  2. Universidad Central de Venezuela, ciudad universitaria, Caracas, 1062, Venezuela

    Emilia Diaz

  3. Universidad Central de Venezuela, ciudad universitaria, Caracas, 1062, Venezuela

    Maritza Padrón-Nieves

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Sundar, S., Chakravarty, J. (2013). Visceral Leishmaniasis. In: Ponte-Sucre, A., Diaz, E., Padrón-Nieves, M. (eds) Drug Resistance in Leishmania Parasites. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1125-3_9

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