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Am. J. Trop. Med. Hyg., 80(4), 2009, pp. 580-582
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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SHORT REPORT


Relapse of Visceral Leishmaniasis after Miltefosine Treatment in a Nepalese Patient

Basu Dev Pandey*, Kishor Pandey, Osamu Kaneko, Tetsuo Yanagi, AND Kenji Hirayama
Sukraraj Tropical and Infectious Diseases Hospital, Kathmandu, Nepal; Department of Immunogenetics, Department of Protozoology, and Animal Research Center for Tropical Infections, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan

 

ABSTRACT

We report the first case of visceral leishmaniasis (VL) relapse in a healthy individual after complete miltefosine treatment. The patient attended hospital with a history of fever for 2 months, splenomegaly, hepatomegaly, and weight loss. The case was confirmed as VL by microscopical detection of Leishmania parasites in a bone marrow specimen and by a positive result for the immunochromatography-based test targeting the Leishmania donovani rK39 antibody. A polymerase chain reaction (PCR) specific for the Leishmania kinetoplast minicircle gene was positive, and subsequent sequencing of the PCR-amplified product confirmed that this case was a L. donovani infection. The patient was treated with miltefosine for 28 days, during which time the response was good, and the Leishman-Donovan body (LD body) was negative on discharge. Ten months later, however, this patient again developed high fever and splenomegaly, and LD bodies and rK39 antibody were positive, thus indicating a relapse of VL. The patient was subsequently treated with 1 mg/kg of amphotericin B for a total of 14 days and recovered completely.

Received October 9, 2008. Accepted for publication December 14, 2008.

Acknowledgments: The authors thank all the staff of Sukraraj Tropical and Infectious Diseases Hospital for support in the treatment. We also thank Dr. Richard Culleton for critically reading this manuscript.

Financial support: KP was supported by a scholarship from the Japanese Government Ministry of Education, Science, Sports and Culture (MONBUSHO). This study was supported by the National Bio-Resource Project (NBRP) of MEXT, Japan.

* Address correspondence to Basu Dev Pandey, Sukraraj Tropical and Infectious Diseases Hospital, Kathmandu, Nepal. E-mail: basupandey{at}wlink.com.np

Authors’ addresses: Basu Dev Pandey, Sukraraj Tropical and Infectious Diseases Hospital, Kathmandu, Nepal, Tel: (+977) 1 5590524, Fax: (+977) 1 4253396, E-mail: basupandey{at}wlink.com.np. Kishor Pandey, Department of Veterinary Microbiology, Faculty of Agriculture, The University of Tokyo, 1-1-1 Yayoi, Tokyo, Japan, Tel: (+81) 358415398, Fax: (+81) 3 5841 8184, E-mail: pandey_kishor{at}hotmail.com. Osamu Kaneko, Department of Protozoology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan, Tel: +81-95-819-7838, Fax: +81-95-819-7805, E-mail: okaneko{at}nagasaki-u.ac.jp. Tetsuo Yanagi, Animal Research Center for Tropical Infectious, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan, Tel: +81-95-819-7856, Fax: +81-95-819-7805, E-mail: f1020{at}cc.nagasaki-u.ac.jp. Kenji Hirayama, Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan, Tel: +81-95-819-7818, Fax: +81-95-819-7805, E-mail: hiraken{at}nagasaki-u.ac.jp.






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