0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15
Leishmaniasis, Visceral Leptospirosis, Relapsing Fever 893Side Effects & Complications
■Sodium stibogluconate: myalgias, arthralgias, nausea, anorexia,
malaise are common. EKG changes, pancreatitis, renal impairment,
abnormal liver function, anemia, neutropenia, thrombocytopenia
may all be seen.
■Liposomal amphotericin B: fever, chills, cough, wheeze, renal
impairment, hypokalemia, all generally less severe than plain amp-
hotericin B.
■Contraindications to treatment: absolute: asymptomatic patient.
■Contraindications to treatment: relative: none.follow-up
During Treatment
■Sodium stibogluconate: CBC, creatinine, EKG, pancreatic enzymes,
LFTs must be followed. Interrupt treatment if severe problems.Routine
■Clinical follow-up (temperature, weight, liver and spleen size), blood
counts, and periodic assessment for parasites (bone marrow or
splenic puncture). Retreatment may be needed, and follow-up for
relapse is important.complications and prognosis
■Many cases from India are resistant to sodium stibogluconate and
require amphotericin. Assuming the parasites are eliminated, prog-
nosis is good. Untreated or partly treated cases have a poor prognosis.
In immunosuppressed patients the infection is often incurable, and
monthly or bimonthly injections of Pentostam or amphotericin may
be needed.LEPTOSPIROSIS, RELAPSING FEVER AND
RAT-BITE FEVER
RICHARD A. JACOBS, MD, PhD
history & physical
History
■Leptospirosis caused by Leptospira interrogans, a Gram-negative
spirochete that contains 23 serogroups and >200 serovars; most com-
mon human pathogens are L. icterohaemorrhagiae (found in rats),
L. canicola (dogs) and L. pomona (cattle and swine).