Short-course, low-dose amphotericin B lipid complex therapy for visceral leishmaniasis unresponsive to antimony.

BACKGROUND: Visceral leishmaniasis (kala-azar) is a worldwide, disseminated intracellular protozoal infection for which prolonged, conventional therapy with pentavalent antimony has become increasingly less effective. OBJECTIVE: To determine the efficacy and minimal effective dose of short-course therapy with amphotericin B lipid complex in visceral leishmaniasis. DESIGN: A randomized, open-label study. SETTING: Inpatient kala-azar treatment unit in the state of Bihar in northeast India, where visceral leishmaniasis is endemic. PATIENTS: 60 patients with active infection who had not responded to or who had relapse after receiving conventional (> 30 days) treatment with pentavalent antimony. INTERVENTION: Intravenous amphotericin B lipid complex was given once daily for 5 consecutive days by 2-hour infusion. Patients were randomly assigned to receive 1, 2, or 3 mg/kg of body weight per day (total doses of 5, 10, or 15 mg/kg, respectively). MEASUREMENTS: Clinical and parasitologic responses (the latter were measured by parasite density score of the splenic aspirate) were determined 14 days after treatment. Definitive responses were assessed 6 months after treatment according to clinical outcomes and findings on examination of bone marrow aspirate. RESULTS: All 60 patients responded to 5 days of treatment. Fourteen days after therapy, all patients had parasite-free splenic aspirates and were considered to have an apparent clinical and parasitologic response. Six months after therapy, definitive responses were documented in 16 of 19 (84% [95% Cl, 60% to 97%]), 18 of 20 (90% [Cl, 68% to 99%]), and 21 of 21 (100% [Cl, 84% to 100%]) patients who received total doses of 5, 10, and 15 mg/kg, respectively. CONCLUSION: Short-course therapy with low-dose amphotericin B lipid complex is effective for visceral leishmaniasis and is an important therapeutic alternative in the management of this serious intracellular protozoal infection.

Current use and future directions of adenovirus vaccine.

Adenoviruses are a major cause of respiratory illnesses in military recruits and also are common causes of respiratory and gastrointestinal infections during childhood. Forty-one serotypes of human respiratory and enteric adenoviruses have been identified. Live, oral adenovirus vaccines developed for the military and tested in large clinical trials have proved to be safe and highly effective in decreasing hospitalizations related to adenoviral acute respiratory diseases. Studies have demonstrated little horizontal transmission among military personnel but substantial transmission among family members. Use of recombinant techniques have opened new opportunities for the development of recombinant adenovirus vector vaccines against a number of viral pathogens such as hepatitis B, human immunodeficiency, herpes simplex and respiratory syncytial virus.

A rapid immunofluorescent procedure for serodiagnosis of Q fever in mice, guinea pigs, sheep, and humans.

The ability to diagnose Q fever has been hampered by the fact that diagnosis depends upon difficult serologic tests such as complement fixation (CF) or slide immunofluorescence performed only at reference laboratories. A new quantitative solid phase fluorescent antibody test (FIAX) has recently been developed and applied to measure antibodies in several microbial systems. The test takes less than 2 hr to perform and employs stable reagents. We have utilized this technique and developed a rapid immunofluorescent assay for detection of antibodies to Coxiella burnetii in man and animals. Sera from guinea pigs and mice immunized with phase I vaccine and from naturally infected sheep show high levels of fluorescence against both phase I and phase II antigens by this technique. We have tested over 100 CF positive humans from a recent laboratory outbreak of Q fever and find an excellent correlation between FIAX and CF results.