monitoring toxicity associated with parenteral sodium stibogluconate in the day-case management of returned travellers with new world cutaneous leishmaniasi监测毒性与肠外钠stibogluconate day-case管理返回的旅行者与世界新皮leishmaniasi.pdfVIP

Monitoring Toxicity Associated with Parenteral Sodium Stibogluconate in the Day-Case Management of Returned Travellers with New World Cutaneous Leishmaniasi 1 1 2 1 Emily S. Wise *, Margaret S. Armstrong , Julie Watson , Diana N. Lockwood 1 Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom, 2 Department of Parasitology, Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom Abstract Background: Patients with New World cutaneous leishmaniasis (NWCL) caused by Leishmania Viannia are treated with parenteral sodium stibogluconate (SbV) to reduce the risk of development of mucocutanous leishmaniasis. Our centre manages patients with NWCL on an outpatient-basis. This study was conducted to assess the safety and efficacy of this approach. Methodology: We reviewed records of 67 consecutive NWCL patients, aged 17–61 years, treated as day-cases with 20 mg/ kg/day SbV for up to 28 days at our UK centre. Data had been collected in a standardised format at the time of treatment using a care-record tool. Patients reported adverse-effects daily using a structured questionnaire. Blood tests and electrocardiograms were performed twice weekly to monitor for toxicity. Principal Findings: Parenteral SbV treatment was associated with an early, significant suppression of mean lymphocyte and platelet counts. By day four of treatment, lymphocytes reduced by 0.53 6109 9 9 /L (CI 0.29 610 /L to 0.76 610 /L, p ,0.001), and platelets by 31,000/mL (CI 16,000/mL to 46,000/mL, p ,0.001). SbV was further as