Kala-Azarlı çocuk hastalarda lipozomal amfoterisin B ile tedavi deneyimi

Abstract

Amaç: Kala-azar retikuloendotelial sistemin multisistemik enfeksiyonudur. hepatosplenomegali ve hipergamaglobulinemi ile karakterizedir. pentavalan antimon bileşikleridir. Tedavide antimon içeren ilaçlara karşı direnç gelişmesi ve antimon bileşiklerinin yan etkileri nedeniyle lipozomal amfoterisin B kullanımı gündeme gelmiştir. Çalışmamızda kala-azarlı çocuk hastaların tedavisinde 6 aylık lipozomal amfoterisin B tedavisi deneyimlerimizi sunmayı amaçladık. Yöntem: Ocak 2014-Haziran 2014 tarihleri arasında Mustafa Kemal Üniversitesi Tıp Fakültesi Hastanesi'nde tanı alan 6 visseral leishmaniasisli olgu retrospektif olarak incelendi. Tüm hastalar lipozomal amfoterisin B (AmBisome®) ile tedavi edildi. Bulgular: Tüm hastalara kemik iliği aspirasyonu yapıldı ve tümünde Leishmania amastigotları görüldü. Olguların hepsinde ateş, hepatomegali ve splenomegali vardı. En sık hematolojik bulgu anemi (%100) ve nötropeni (%100) idi. Olguların beşinde hipergamaglobulinemi saptandı. Bir olguda Hemofagositik lenfohistiyositozis (HLH) saptandı. Uygun leishmaniasise.

Objective: Kala-azar is a multisystem infection of the reticuloendothelial system. It is characterized by prolonged fever, hypergammaglobulinemia. The conventional treatment of kala-azar consists of pentavalent antimony compounds. Because of the resistance to drugs, including antimony and the side effects of antimony compounds, liposomal amphotericin B therapy is now being used. In our study, we aimed to present our 6 months of experience about treatment with liposomal amphotericin B of pediatric patients with kala-azar. Method: In this study, 6 consecutive cases of visceral leishmaniasis admitted to Mustafa Kemal University Medical Faculty Hospital between January 2014 and June 2014 were analyzed retrospectively. All patients with kalaazar were treated with liposomal amphotericin B (AmBisome®). Results: Bone marrow aspirate was obtained in all cases and Leishmania amastigotes were detected in all of them. Fever, hepatomegaly and splenomegaly were present in all cases. Anemia (100%) and neutropenia (100%) were the most Hypergammaglobulinemia was noted in 5 cases. Severe Hemophagocytic lymphohistiocytosis (HLH) secondary to visceral leishmaniasis revealed in 1 patient. Despite initiating appropriate antileishmanial and HLH 2004 protocol treatments, She died after 19 days of hospitalization due to acinetobacter septicemia. In 5 patients were finally cured. Conclusion: Kala-azar should be suspected in the differential diagnosis with prolonged fever, marked splenomegaly hepatomegaly, and cytopenia. Liposomal amphotericin B seems to be the effective therapy in the treatment of pediatric visceral leishmaniasis in Turkey.