Case Report: Use of Liposomal Amphotericin B in Low Doses in Patients With Visceral Leishmaniasis

Hemophagocytic lymphohistiocytosis secondary to visceral leishmaniasis in children: case report and systematic review

Background

Visceral leishmaniasis (VL) can lead to complications such as hemophagocytic lymphohistiocytosis (HLH) in children. The clinical features of VL overlap with that of HLH, and thus the diagnosis of VL-induced HLH can be challenging for clinicians.

Methods

We describe two pediatric cases and systematically review all reported cases of pediatric VL-related HLH in literatures until May 2024.

Results

The demographic characteristics, clinical manifestations, treatment and prognosis of our reported cases are presented. The systematic review included 29 articles with a total of 135 cases. More than half of the children (89/125, 71.2%) were under 3 years old, and 8.9% (n = 12/135) had specific epidemiological histories. The main clinical presentations were hypertriglyceridemia (34/45, 75.6%), hypofibrinogenemia (24/36, 66.7%), and hyperferritinemia (95/132, 72.0%). Bone marrow aspiration (BMA) analysis indicated positive evidence of leishmania infection in 84.7% (83/98) of cases, while 37.8% (14/37) of patients tested negative for leishmania on the first BMA smear. All patients were treated against leishmania with amphotericin B (76/135, 56.3%) or antimony (77/135, 57.0%), and 13.3% (n = 18/135) of patients received both medications, in which amphotericin B was used as rescue treatment. The prognosis was favorable, with the exception of two deaths.

Conclusions

Vigilance towards screening for leishmania infection induced HLH is imperative, particularly when there is a suspicious epidemiological history, ineffective chemotherapy, or prior to bone marrow transplantation. Early recognition, accurate diagnosis, and prompt treatment initiation can significantly alter the course of the disease and favor the prognosis in childhood with HLH secondary to VL.

Exploring Mono and Bis-gold(I)-DTC Complexes Against Cancer and Leishmania

Cancer is one of the main challenges of global public health and a leading cause of death, hindering the increase in life expectancy, and leishmaniasis occupies the second position in the number of deaths from parasitic diseases. Gold(I)-based drugs are being studied for chemotherapy and have shown promising results, leading to the search for analogs with more favorable effect profiles. This work presents the synthesis and characterization of five new gold(I) complexes, [AuIDTCPPh3] and [AuI 2DTC(PPh3)2], using dithiocarbamate-derived ligands and triphenylphosphine, with potential biological activity. The antiproliferative activity was investigated in breast tumor cell lines (MDA-MB-231 and 4T1) and a non-tumor breast cell line (MCF-10a), showing that complexation with gold enhances cytotoxic activity. The antileishmanial activity was investigated against intracellular amastigotes of Leishmania (Viannia) braziliensis, L. (Leishmania) amazonensis, and L. (L.) infantum. All complexes demonstrated promising activity, especially the bis-gold(I) complexes, which showed higher activity in the studied cell lines and Leishmania parasites. The results show the importance of the gold atom in these compounds, supporting the development of gold-based compounds as prototypes for metallodrugs.

Navigating Diagnosis and Treatment Dilemmas in Visceral Leishmaniasis Reactivation in a HIV-Positive Patient

Reactivation of visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)-positive patients poses complex management challenges, requiring tailored treatment approaches and robust follow-up strategies. There are very few case reports of visceral leishmaniasis (VL) published in Sri Lanka as of today. Here, we present a case of a 38-year-old, HIV-positive male who was treated for a reactivation of VL. He presented with a prolonged febrile illness without an identifiable infection focus. The evaluation confirmed VL reactivation. Using current evidence-based guidelines, our patient was treated with intravenous liposomal amphotericin B and achieved a parasitological cure.  By exploring the challenges associated with managing VL among HIV-positive individuals, we emphasize the importance of reliable follow-up protocols and investigations to assess treatment success, ensuring optimal patient outcomes.