Volume 80, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 parasites in a bone marrow specimen and by a positive result for the immunochromatography-based test targeting the rK39 antibody. A polymerase chain reaction (PCR) specific for the kinetoplast minicircle gene was positive, and subsequent sequencing of the PCR-amplified product confirmed that this case was a infection. The patient was treated with miltefosine for 28 days, during which time the response was good, and the 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.


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  1. World Health Organization, 2002. The World Health Report 2002. Reducing Risks, Promoting Healthy Life. Geneva, Switzerland: World Health Organization.
  2. Sundar S, Mondal D, Rijal S, Bhattacharya S, Ghalib H, Kroeger A, Boelaert M, Desjeux P, Richter-Airijoki H, Harms G, 2008. Implementation research to support the initiative on the elimination of kala azar from Bangladesh, India and Nepal: the challenges for diagnosis and treatment. Trop Med Int Health 13 : 2–5. [Google Scholar]
  3. Desjeux P, 2004. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis 27 : 305–318. [Google Scholar]
  4. Minister of Health Nepal, 2007. The Internal Assesment of Malaria, Kalaazar Control Activites 2004, 2005, 2006. Kathmandu, Nepal: Ministry of Health, Directorate of Health Service, Epidemiology and Disease Control Division.
  5. World Health Organization, 1990. Control of the leishmaniases. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 793 : 1–158. [Google Scholar]
  6. Olliaro PL, Guerin PJ, Gerstl S, Haaskjold AA, Rottingen JA, Sundar S, 2005. Treatment options for visceral leishmaniasis: a systematic review of clinical studies done in India, 1980–2004. Lancet Infect Dis 5 : 763–774. [Google Scholar]
  7. Sundar S, Murray HW, 2005. Availability of miltefosine for the treatment of kala-azar in India. Bull World Health Organ 83 : 394–395. [Google Scholar]
  8. Pandey K, Pant S, Kanbara H, Shuaibu MN, Mallik AK, Pandey BD, Kaneko O, Yanagi T, 2008. Molecular detection of Leishmania parasites from whole bodies of sandflies collected in Nepal. Parasitol Res 103 : 293–297. [Google Scholar]
  9. Karki P, Koirala S, Parija SC, Handsak SG, Das ML, 1998. A thirty day course of sodium stibogluconate for treatment of kala-azar in Nepal. Southeast Asian J Trop Med Public Health 29 : 154–158. [Google Scholar]
  10. Rijal S, Chappuis F, Singh R, Bovier PA, Acharya P, Karki BM, Das ML, Desjeux P, Loutan L, Koirala S, 2003. Treatment of visceral leishmaniasis in south-eastern Nepal: decreasing efficacy of sodium stibogluconate and need for a policy to limit further decline. Trans R Soc Trop Med Hyg 97 : 350–354. [Google Scholar]
  11. Sundar S, 2001. Drug resistance in Indian visceral leishmaniasis. Trop Med Int Health 6 : 849–854. [Google Scholar]
  12. Seifert K, Matu S, Javier Perez-Victoria F, Castanys S, Gamarro F, Croft SL, 2003. Characterisation of Leishmania donovani promastigotes resistant to hexadecylphosphocholine (miltefosine). Int J Antimicrob Agents 22 : 380–387. [Google Scholar]
  13. Troya J, Casquero A, Refoyo E, Fernández-Guerrero ML, Górgolas M, 2008. Long term failure of miltefosine in the treatment of refractory visceral leishmaniasis in AIDS patients. Scand J Infect Dis 40 : 78–80. [Google Scholar]
  14. Sindermann H, Engel KR, Fischer C, Bommer W, 2004. Oral miltefosine for leishmaniasis in immunocompromised patients: compassionate use in 39 patients with HIV infection. Clin Infect Dis 39 : 1520–1523. [Google Scholar]
  15. Perez-Victoria FJ, Gamarro F, Ouellette M, Castanys S, 2003. Functional cloning of the miltefosine transporter. A novel P-type phospholipid translocase from Leishmania involved in drug resistance. J Biol Chem 278 : 49965–49971. [Google Scholar]
  16. Calvopina M, Gomez EA, Sindermann H, Cooper PJ, Hashiguchi Y, 2006. Relapse of new world diffuse cutaneous leishmaniasis caused by Leishmania (Leishmania) mexicana after miltefosine treatment. Am J Trop Med Hyg 75 : 1074–1077. [Google Scholar]
  17. Zerpa O, Ulrich M, Blanco B, Polegre M, Avila A, Matos N, Mendoza I, Pratlong F, Ravel C, Convit J, 2007. Diffuse cutaneous leishmaniasis responds to miltefosine but then relapses. Br J Dermatol 156 : 1328–1335. [Google Scholar]

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  • Received : 09 Oct 2008
  • Accepted : 14 Dec 2008

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