[Leish-l] name

Wed Apr 21 05:09:56 BRT 2010

Dear Dr Basu,
This sounds like a complicated and challenging case. In summary this is a 42 year old with multiple episodes of relapse that is now showing incomplete parasitological response at end of treatment.
There are a few issues to consider:
1)       Does the patient have evidence of another important co-infection: particularly HIV or TB? I would screen for both. In the case of HIV, there may be little chance of ever achieving sterile cure even if on ART. In HIV co infected cases, patients have often been managed by maintenance treatment or secondary prophylaxis. However there is perhaps less chance of success if initial parasitological cure is not achieved.
2)       Nutritional deficiencies (both macro and micronutrients) should be addressed through appropriate therapeutic feeding/ nutritional supplementation depending on severity.
3)       You mention that the patient has been treated with Lipid Complex Amphotericin B? Do you specifically mean Ambisome or is it some other formulation of amphotericin B. If it's the latter (i.e. not given AmBisome), it may be worth trying a course of Ambisome 5mg/kg over 4 doses (e.g. higher dose for this case) if you can get hold of the stuff.
4)       In the event there is no evidence of any overt co-infection: if the patient is clinically will, one could consider a repeat visit in one month. I think the next course of treatment in this scenario could perhaps be a combination of drugs (on a compassionate basis: e.g. AmBisome and Miltefosine). Since this is a case of multiple unresponsiveness, one could try full courses of both, depending on how well tolerated this is (perhaps this may be controversial- but there is very little guidance . You could also consider trying paramomycin (though availability will be difficult since I understand it is not yet registered and available in Nepal).

I am not sure how useful this feedback is. I wonder if any of the other clinicians out there have any other opinions?
regards

________________________________
From: leish-l-bounces at lineu.icb.usp.br [mailto:leish-l-bounces at lineu.icb.usp.br] On Behalf Of Dr.Basu Pandey
Sent: Tuesday, April 20, 2010 5:12 PM
To: leish-l at lineu.icb.usp.br; Sinval Pinto Brandão Filho
Subject: Re: [Leish-l] name

Dear all

We have a 42 years old patients with VL here in Nepal treated initially with Amphotoricin B in another center incompletely. This patients also received Meltefosine for 28 days few months back. He was referred to our hospital 2 months ago with fever and spleenomegaly. Bone marrow aspiration showed positive for LD bodies. We treated the patients with Lipid complex ambhotoricin 5 mg/kg alternate daily for five days. The spleen size reduced and patients  was discharged and asked him to come hospital after month. During his hospital visit we performed Bone marrow aspiration showed planty of LD bodies. Since we have no other choice we started Ambhotoricn B 1mg/kg daily for 21 days. The spleen size almost not palpable and on 22 days after the treatment we performed  bone marrow which shows scanty LD bodies.
Anyone can suggest for the furthere plan.

Thanks,

Dr. Basu Dev Pandey, MD, PhD
Sukra Raj Infectious and Tropical Disease Hospital
Teku, Kathmandu, Nepal
Tel: 977-1-4253395
Email: basupandey at wlink.com.np<mailto:basupandey at wlink.com.np>
----- Original Message -----
From: Sinval Pinto Brandão Filho<mailto:sinval at cpqam.fiocruz.br>
To: leish-l at lineu.icb.usp.br<mailto:leish-l at lineu.icb.usp.br>
Sent: Sunday, April 18, 2010 1:52 AM
Subject: Re: [Leish-l] name

There is a consensus in the different opinions, perfectly explained in the messages of professors Killick, Ashford and Bryceson: anthroponotic visceral leishmaniasis and zoonotic visceral leishmaniasis. The name calazar used in Brazil is only an neologism derived of kala-azar to the common name for the clinical form of the disease visceral leishmaniasis, also used in the classical book "Calazar Canino" of professor Joaquim Alencar for the disease form in dogs.

According the WHO technical report, leishmaniasis, not leishmaniosis.

Sinval

De: leish-l-bounces at lineu.icb.usp.br [mailto:leish-l-bounces at lineu.icb.usp.br] Em nome de Carlos Costa
Enviada em: quinta-feira, 8 de abril de 2010 08:14
Para: Christopher Peacock
Cc: Leish-L
Assunto: Re: [Leish-l] name

Dear,

Now, urban kala-azar is endemic in many Brazilian state capitals, and everybody, doctors and the media, calls it as "calazar". However, in most Brazilian scientific papers, "visceral leishmaniasis" ("leishmaniose visceral", in Portuguese) is preferred, specially when the text is written in English.

Another point is that if one says just "leishmaniose" in Brazil it will be generally understood as cutaneous leishmaniasis. To be understood as the systemic disease one must say "calazar" or "leishmaniose visceral".

Another intriguing spelling is the use of both leishmaniasis and leishmaniosis, in English texts.  Are there rules for it?

Cheers,

Carlos.

2010/4/8 Christopher Peacock <cpeacock at cyllene.uwa.edu.au<mailto:cpeacock at cyllene.uwa.edu.au>>

Interesting that the Hindi name (Kala = black azar = fever) has been taken up and brazlianised so effectively, when I was in the North East of Brasil researching VL  in 1992-94 don't recall anyone using the term calazar, they generally called it leishmaniose. It is also odd that L chagasi doesn't darken the skin in the same way L. donovani does so the entire meaning has been lost.

Cheers

Chris

From: Carlos Costa [mailto:chncosta at gmail.com<mailto:chncosta at gmail.com>]
Sent: Wednesday, 7 April 2010 5:44 PM
To: Christopher Peacock
Cc: Leish-L

Subject: Re: [Leish-l] name

Interestingly, kala-azar has been adopted plenty in Brazil as "calazar", since the earlier scientific papers. However, it was adopted by authors from the Northeast, which is the main endemic area, like Prata and Alencar. Today, both names are normally use, but one may feel that visceral leishmaniasis could stand as more educated and kala-azar (calazar), as more informal, although, in my view both are interchangeable.

Carlos.

2010/4/6 Christopher Peacock <cpeacock at cyllene.uwa.edu.au<mailto:cpeacock at cyllene.uwa.edu.au>>

Kala-azar is the Indian name for visceral leishmaniasis so used extensively in the Indian sub continent, it literally means black skin in Hindi I believe. Visceral leishmaniasis is the proper generic name for systemic leishmaniasis caused by L. donovani, L. infantum and L. (infantum) chagasi. Leishmaniasis has a vast array of names depending on the type and geographical location, there was a post on the number of names a few years ago.

From: leish-l-bounces at lineu.icb.usp.br<mailto:leish-l-bounces at lineu.icb.usp.br> [mailto:leish-l-bounces at lineu.icb.usp.br<mailto:leish-l-bounces at lineu.icb.usp.br>] On Behalf Of Carlos Costa
Sent: Wednesday, 24 March 2010 7:02 AM

To: Leish-L
Subject: [Leish-l] name

Visceral leishmaniasis or kala-azar? Which, when, how?

Carlos.

--
Carlos H. N. Costa, MD, DSc.
Instituto de Doenças Tropicais Natan Portella
Universidade Federal do Piauí
Brazil
Telephone: +55 86 3221-3413

--
This message has been scanned for viruses and
dangerous content by MailScanner<http://www.mailscanner.info/>, and is
believed to be clean.

________________________________

This e-mail message has been scanned for Viruses and Content and cleared by MailMarshal

________________________________

--
Carlos H. N. Costa, MD, DSc.
Instituto de Doenças Tropicais Natan Portella
Universidade Federal do Piauí
Brazil
Telephone: +55 86 3221-3413

As informações contidas nesta mensagem são CONFIDENCIAIS, protegidas pelo sigilo legal, por direitos autorais e destinadas exclusivamente à pessoa ou organização para a qual a mensagem foi destinada.
Warning: This message is meant only for the intended recipient of the transmission.  It is forbidden any unauthorized use, alteration, reproduction and distribution. If you are not the correct recipient, please notify us immediately by return e-mail and delete this message from your system.

--
Carlos H. N. Costa, MD, DSc.
Instituto de Doenças Tropicais Natan Portella
Universidade Federal do Piauí
Brazil
Telephone: +55 86 3221-3413

As informações contidas nesta mensagem são CONFIDENCIAIS, protegidas pelo sigilo legal, por direitos autorais e destinadas exclusivamente à pessoa ou organização para a qual a mensagem foi destinada.
Warning: This message is meant only for the intended recipient of the transmission.  It is forbidden any unauthorized use, alteration, reproduction and distribution. If you are not the correct recipient, please notify us immediately by return e-mail and delete this message from your system.

________________________________
_______________________________________________
Leish-l mailing list
Leish-l at lineu.icb.usp.br
http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://lineu.icb.usp.br/pipermail/leish-l/attachments/20100421/02d5d228/attachment-0001.htm>