VISCERAL LEISHMANIASIS UNRESPONSIVE TO AN TIMONIAL DRUGS - RISK-FACTORS AND TREATMENT

Background.- Resistance to antimonial drugs is rarely observed in immu nocompetent patients. Case report.- A 1 year-old girl was admitted suf fering from persistent fever. A diagnosis of visceral leishmaniasis wa s made. The patient was given two courses of meglumine antimoniate (Gl ucantime(R)) (60 mg/kg/d for 15 days) and one course of 12 injections of pentamidine (4 mg/kg). She relapsed 8 months later and failed to re spond to Glucantime(R). Immunological tests performed during the relap se showed a suppression of the T cell response to Leishmania antigen a nd no production of interferon gamma. The patient was then sucessfully given liposomal amphotericin B (3 mg/kg/d for 10 days). She wets asym ptomatic 9 months later and had acquired specific cellular immunity ag ainst Leishmania. Conclusion.- Deficient cell-mediated immunity and in terferon gamma production are some factors responsible for decreased s ensivity to antimonial drugs. The WHO recommendations treating viscera l leishmaniasis with prolonged administration of Glucantime(R) may pre vent relapses. Liposomal amphotericin B could be an alternative treatm ent.