“One in five people treated for a serious form of leishmaniasis in Nepal relapse after a year,” Nature reports, adding, “The finding, published in Clinical Infectious Diseases last month, is ‘an alarming signal’ for campaigns to eliminate the neglected disease, say researchers.” The news service notes, “The orally administered drug miltefosine emerged as the treatment of choice a decade ago, taking over from injections of the highly toxic, antimony-based drug sodium stibogluconate, which had started showing failure rates of 65 percent in India’s northern state of Bihar.” However, “reports are now emerging of miltefosine failure, which scientists worry will narrow down the pipeline of drugs available for treatment,” the news service adds.

“In the latest study, a team of researchers from Belgium, Nepal and the Netherlands identified 187 cases of visceral leishmaniasis in Nepal, of whom 120 were treated with miltefosine,” Nature writes, noting, “Six months after treatment with miltefosine, 10 percent of cases had relapsed; after a year, that had doubled to 20 percent.” The magazine continues, “The cause of the relapses is unknown: they were not attributable to fresh infections; to co-infection with HIV, which reduces the host’s immunity; to low drug quality; to poor adherence to the treatment regime; or to drug resistance in the parasite.” Nature adds, “Whatever the causes of the failure, ‘these new results support the recommendation to discontinue miltefosine monotherapy,’ [Manica Balasegaram of Médecins Sans Frontières] says” (3/8).