Other superinfections
VL patients often have other superinfections. These include fungal skin infections (ptyriasis), otitis media, pneumonia, gastroenteritis, bacterial sepsis, injection site abscess and thrombophlebitis. The selection and route of antimicrobial should depend on the severity of infection, availability of drugs and known local etiologic agent and sensitivity pattern. Here are some suggestions:
|
Infections |
Treatment options |
|
Skin fungal infections |
Ketoconazole topical cream, Nystatin (VL treatment with AmBisome can partially treat fungal infections, however, systemic fungal infection require much higher dose than is used for the treatment of VL) |
|
Otitis media |
Amoxicillin |
|
Pneumonia |
Ceftriaxone |
|
Gastroenteritis |
Ciprofloxacin, Ceftriaxone (or depending on the etiology on microscopy, culture examination) |
|
Bacterial sepsis |
Ceftriaxone+Metronidazole; Cloxacillin (or vancomycin if MRSA is suspected can be considered too) |
|
Injection site abscess, thrombophlebitis |
Cloxacillin, (vancomycin if MRSA is suspected) and abscess drainage |
References:
Diro E, et al. (2014) Visceral Leishmaniasis and HIV Coinfection in East Africa. PLOS Negl Trop Dis 8(6)
Diro E, et al High Parasitological Failure Rate of Visceral Leishmaniasis to Sodium Stibogluconate among HIV Co-infected Adults in Ethiopia. PLoS Negl Trop Dis. 2014 May 22;8(5)
Diro E et al, Atypical manifestations of visceral leishmaniasis in patients with HIV in north Ethiopia: a gap in guidelines for the management of opportunistic infections in resource poor settings. Lancet Infect Dis 2014
Diro E, et al (2015) Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study. PLoS Negl Trop Dis 9(10)