Complications
Elevation of amylase and lipase occurs in almost all patients but does not require treatment interruption in most asymptomatic patients.
In contrast, acute clinical pancreatitis can be potentially lethal and necessitates transient or definitive interruption of treatment.
HIV-coinfected patients are at particular risk.
Bacterial superinfection is possible in cutaneous leishmaniasis, especially if lesions are ulcerative or open to the air (e.g., feet, hands) and in environments of poor hygiene.
Infection can also occur when lesions are treated with thermotherapy due to the localized second-degree burn.
Superinfection can delay treatment response.
Topical or systemic antibiotic treatment should be applied in cases of bacterial superinfection. Topical antibiotics can be given after application of thermotherapy to prevent superinfection.
The immunosuppression induced by visceral leishmaniasis favors potentially lethal bacterial infections such as dysentery, pneumonia, and sepsis.
Patients must have a careful physical exam performed before and during treatment.
Suspected or proven bacterial infections must be treated early with appropriate antibiotics.
More frequently reported during treatment of visceral leishmaniasis than cutaneous leishmaniasis. Can be fatal.
Patients with HIV coinfection, underlying cardiopathy, or electrolyte disorders are at particular risk.
ECG monitoring is recommended during treatment. Treatment should be transiently or definitely interrupted if ominous signs develop (e.g., marked ST-T wave changes or prolonged corrected QT interval >0.5 second).
Frequent and potentially lethal adverse effect of amphotericin-B deoxycholate.
Monitoring of blood potassium and creatinine necessary.
If monitoring not possible, treatment on alternate days is preferable.
Risk reduced by administration of supplemental sodium chloride and electrolytes and by avoidance of dehydration.
Nephrotoxicity is less commonly reported with liposomal amphotericin-B, but remains a significant concern.
Epistaxis occurs commonly in visceral leishmaniasis (VL) and is typically benign. On occasion, severe intestinal bleeding can occur in VL, leading to shock or worsening of preexisting anemia.
Disease-related thrombocytopenia is likely to be the main cause of the bleeding tendency.
Vital signs must be closely monitored during treatment, and blood should be transfused in case of severe bleeding or severe anemia.
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