Case Report: Treatment of Widespread Nodular Post kala-Azar Dermal Leishmaniasis with Extended-Dose Liposomal Amphotericin B in Bangladesh: A Series of Four Cases

Ariful Basher Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh;

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Shomik Maruf Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Proggananda Nath Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh;

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Md Golam Hasnain Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle (UoN), New South Wales (NSW), Australia;

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Muhammod Abdul Mukit Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh;

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Azim Anuwarul Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh;

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Fatima Aktar Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Rupen Nath Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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AFM Akhtar Hossain National Kala-azar Elimination Program (NKEP), Directorate General Health Services (DGHS); Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GoB), Dhaka, Bangladesh;

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Abul Hasnat Milton Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle (UoN), New South Wales (NSW), Australia;

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Dinesh Mondal Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Abul Khair Mohammad Sumsuzzaman Disease Control Unit, Directorate General Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GoB), Dhaka, Bangladesh;

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Ridwanur Rahman Department of Medicine, Shaheed Suhrawardi Medical College and Hospital (SSMCH), Dhaka, Bangladesh;

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M. A. Faiz Dev Care Foundation, Dhaka, Bangladesh

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Post kala-azar dermal leishmaniasis (PKDL) is a skin manifestation which usually appears after visceral leishmaniasis. It is now proved that PKDL patients serve as a reservoir for anthropometric leishmanial transmission. Hence, to achieve the kala-azar elimination target set by the World Health Organization in the Indian Subcontinent, PKDL cases should be given priority. The goal of treatment for PKDL should be early reepithelizlization and rapid cure, but unfortunately this has been difficult to achieve, especially for patients with severe lesions. Therefore, we describe here four cases of PKDL who had widespread nodular and macular lesions and were treated with two cycles of LAmB doses with 20 mg/kg body weight divided into four equal doses (each dose contains 5 mg/kg) administered every alternate day. This treatment schedule achieved 100% treatment success with the minimal safety concern.

Author Notes

Address correspondence to Ariful Basher, Infection and Tropical Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh. E-mail: ariful.dr@gmail.com

Financial Support: There was no financial support for conducting the activity.

Authors’ addresses: Ariful Basher, Proggananda Nath, Muhammod Abdul Mukit, and Azim Anwarul, Infectious and Tropical Medicine Department, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh, E-mails: ariful.dr@gmail.com, progganath@yahoo.com, mukit.pharma@gmail.com, and azimanwarul@gmail.com. Shomik Maruf, Fatima Aktar, Rupen Nath, and Dinesh Mondal, Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: shomik_stj@yahoo.com, fatimaaktar61@gmail.com, rupennath77@gmail.com, and din63d@icddrb.org. Md Golam Hasnain and Abul Hasnat Milton, Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle (UoN), Newcastle, Australia, E-mails: mdgolam.hasnain@uon.edu.au and milton.hasnat@newcastle.edu.au. AFM Akhtar Hossain, National Kala-azar Elimination Program (NKEP), Directorate General Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GoB), Dhaka, Bangladesh, E-mail: afmhossain@yahoo.com. Abul Khair Mohammad Shamsuzzaman, Disease Control Unit, Directorate General Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GoB), Dhaka, Bangladesh, E-mail: ariful.dr@gmail.com. Ridwanur Rahman, Department of Medicine, Shaheed Suhrawardi Medical College and Hospital (SSMCH), Dhaka, Bangladesh, E-mail: ridwanurr@yahoo.com. M. A. Faiz, Dev Care Foundation, Dhaka, Bangladesh, E-mail: drmafaiz@gmail.com.

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