Diagnosis and Treatment of Leishmania Infections

  • STATUS
    Recruiting
  • participants needed
    200
  • sponsor
    National Institute of Allergy and Infectious Diseases (NIAID)
Updated on 27 May 2022
electrocardiogram
blood tests
diagnostic tests
punch biopsy
apheresis
skin test
amphotericin b
withdrawn
itraconazole
miltefosine
pentostam
cutaneous leishmaniasis
kala-azar

Summary

This study will examine the natural history of Leishmanial infections and their treatments. It will provide an opportunity for NIAID staff to learn more about leishmaniasis and perhaps to improve diagnostic tests for these infections. Patients between 2 and 80 years of age with known or suspected leishmaniasis are eligible for this study.

Participants will have routine blood tests and a biopsy to confirm leishmanial infection. The biopsy procedure will be determined by the type of infection local cutaneous leishmaniasis (LCL), mucocutaneous leishmaniasis (MCL) or visceral leishmaniasis (VL). CL will be confirmed with a punch biopsy, in which a cookie-cutter type razor is used to remove a small circular piece of skin tissue. MCL will be confirmed using a thin flexible tube inserted into the nose. This tube is used to examine the nose and upper airway and to remove a tissue sample, if an affected area is seen. VL will be confirmed with either a bone marrow or liver biopsy or a splenic aspirate. For these procedures, a small tissue sample is withdrawn through a needle placed in the hipbone, liver or spleen, respectively. Some patients may also have a skin test for leishmaniasis similar to tuberculin skin testing.

Treatment and length of hospital stay are determined by the type of infection. CL may be treated with Pentostam, amphotericin, amphotericin B, itraconazole or ketoconazole; ML with amphotericin B, or encapsulated amphotericin; and VL with Pentostam or encapsulated amphotericin. Pentostam is infused daily for 18 to 28 doses, most as an outpatient. Blood is drawn 3 times a week for safety tests and an electrocardiogram is done 2 to 3 times a week to monitor heart rhythm. Amphotericin B is infused every day or every other day for about 30 doses, all on an inpatient basis. Patients undergo hydration (infusion of a large amount of fluid) just before and immediately after each infusion to protect the kidneys. Blood is drawn every other day and urine samples are collected occasionally for routine urinalysis. Encapsulated amphotericin is infused every other day, on an outpatient basis. Blood is generally drawn every other day to every 2 days and urinalyses are done periodically. Itraconazole and ketoconazole are taken orally for at least 1 to 3 months, with blood drawn every 2 to 3 weeks.

Patients may be asked to have photographs taken before, during and after treatment to document progress. They may also be asked to provide extra blood samples for research purposes, either through a vein in the arm or through apheresis, a method for collecting large numbers of cells. For apheresis, whole blood is collected through a needle in an arm vein and circulated through a machine that separates it into its components. The desired cells are then removed, and the rest of the blood is returned to the body, either through the same needle used to draw the blood or through a second needle in the other arm.

Patients with cutaneous leishmaniasis will have a follow-up clinic visit 2 weeks to 3 months after treatment is completed. If there are no complications, their participation will end at that time. Patients with mucocutaneous leishmaniasis and visceral leishmaniasis will be followed every 3 to 6 months indefinitely for routine evaluations and re-treatment if the infection recurs.

Description

Patients admitted on this protocol will have, or be suspected of having, a Leishmania infection. The major objectives of the protocol are to diagnose and classify the Leishmania infection and to provide species-based therapy to study the natural history of the treated infection. As part of the standard evaluation of these patients, infecting parasite isolates will be obtained when possible and the host response before and after therapy will be assessed to address broader questions related to diagnosis, disease pathogenesis and response to therapy. Careful observations of the patients' clinical and immunologic responses to therapy will be made, as well as long-term follow-up of these changes. It is anticipated that the patients will receive optimal clinical care for their infections and that the specimens collected from them will prove to be valuable reagents for the laboratory studies of the host responses unique to leishmanial infections.

Details
Condition Leishmaniasis, Skin Diseases, Parasitic, Euglenozoa Infections, Parasitic Diseases
Clinical Study IdentifierNCT00344188
SponsorNational Institute of Allergy and Infectious Diseases (NIAID)
Last Modified on27 May 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Individuals of either sex greater than age of 3 and less than 100 years
Proven diagnosis of leishmaniasis
Likely diagnosis of leishmaniasis based on
suggestive history
presence of organisms suggestive of leishmania on histopathology/cytology
exposed at the same time as diagnosed pagients with suggestive lesions
epidemiologic-based exposure and compatible histopathology
Willingness to allow samples to be stored for future research
Agree to use 2 methods of birth control (pills or barrier method and abstinence) and delay
pregnancy/fatherhood during treatment and for 6 months after the treatment ends if treated
with miltefosine
Negative pregnancy tests within 24 hours of initiating drug for all systemic treatments

Exclusion Criteria

Individuals who are pregnant or breast feeding, will be excluded from systemic treatments
If the lesion thicksness is greater than 4 mm. ThermoMed treatment cannot be used
Less than 66 lbs. if treated with miltefosine
Those who refuse recommended treatments, evaluations, or follow up
Presence of other life threatening-illness
When treatment is not in the best interest of the patient s well being
Pregnant women will be excluded from receiving ThermoMed treatments
Clear my responses

How to participate?

Step 1 Connect with a study center
What happens next?
  • You can expect the study team to contact you via email or phone in the next few days.
  • Sign up as volunteer to help accelerate the development of new treatments and to get notified about similar trials.

You are contacting

Investigator Avatar

Primary Contact

site

0/250

Additional screening procedures may be conducted by the study team before you can be confirmed eligible to participate.

Learn more

If you are confirmed eligible after full screening, you will be required to understand and sign the informed consent if you decide to enroll in the study. Once enrolled you may be asked to make scheduled visits over a period of time.

Learn more

Complete your scheduled study participation activities and then you are done. You may receive summary of study results if provided by the sponsor.

Learn more

Similar trials to consider

Loading...

Browse trials for

Not finding what you're looking for?

Every year hundreds of thousands of volunteers step forward to participate in research. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.

Sign up as volunteer

user name

Added by • 

 • 

Private

Reply by • Private
Loading...

Lorem ipsum dolor sit amet consectetur, adipisicing elit. Ipsa vel nobis alias. Quae eveniet velit voluptate quo doloribus maxime et dicta in sequi, corporis quod. Ea, dolor eius? Dolore, vel!

  The passcode will expire in None.
Loading...

No annotations made yet

Add a private note
  • abc Select a piece of text from the left.
  • Add notes visible only to you.
  • Send it to people through a passcode protected link.
Add a private note