Miltefosine 50mg capsules

BackgroundVisceral leishmaniasis (VL), also known as kala-azar, is a life-threatening neglected tropical disease primarily caused by Leishmania donovani and transmitted by infected sandflies. Despite notable advancements in public health, VL continues to pose significant challenges, especially in South Asia, East Africa, and South America.MethodsA systematic review was conducted in accordance with PRISMA guidelines. Peer-reviewed literature published from 2000 to 2024 was retrieved from PubMed, Scopus, and Web of Science to assess epidemiological patterns, diagnostic advancements, therapeutic options, and vector control strategies.ResultsThe analysis revealed progress in diagnostic tools such as rK39-based rapid tests and molecular diagnostics. Therapeutic improvements, notably liposomal amphotericin B and miltefosine, have emerged, although drug resistance and limited accessibility remain problematic. Vector control through residual spraying and community programs shows promise but is hindered by insecticide resistance. Furthermore, HIV co-infection and climate-driven spread exacerbate control efforts.ConclusionsComprehensive management of VL requires integrative approaches that combine novel diagnostics, targeted treatment, innovative vector control, and robust public health systems. Emphasis on vaccine development, digital health solutions, and community participation is crucial for sustainable control and eventual elimination.

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Background: and Objectives: Balamuthia mandrillaris granulomatous amoebic encephalitis (GAE) is a rare, frequently fatal central nervous system infection in which delayed recognition remains a major determinant of outcome. The increasing use of metagenomic next-generation sequencing (mNGS), plasma microbial cell-free DNA sequencing and targeted sequencing has changed the diagnostic pathway for unexplained encephalitis, but the survival implications of earlier molecular diagnosis remain unclear. Materials and Methods: A systematic review of peer-reviewed reports published from January 2015 to June 2026 was designed according to PRISMA 2020. Eligible records reported human B. mandrillaris GAE, encephalitis, meningoencephalitis or encephalomyelitis with extractable patient-level diagnostic, treatment or outcome information. Data were narratively synthesised because case definitions, sample types, timing of testing and follow-up were heterogeneous. Results: The evidence base consisted mainly of case reports, small case series and retrospective clinical summaries. Across recent reports, B. mandrillaris GAE commonly mimicked malignancy, tuberculosis, fungal infection, autoimmune encephalitis or bacterial brain abscess. Diagnostic delay was driven by nonspecific symptoms, ring-enhancing lesions, negative routine cultures and limited clinician familiarity with free-living amoebae. Molecular methods, particularly mNGS/NGS applied to cerebrospinal fluid, plasma, blood, brain tissue or bronchoalveolar lavage fluid, repeatedly enabled antemortem diagnosis when routine tests were unrevealing. Survival reports shared a pattern of earlier tissue diagnosis or molecular identification, neurosurgical intervention when feasible, and prolonged multidrug therapy, sometimes including miltefosine or nitroxoline. Conclusions: B. mandrillaris GAE should be considered in subacute encephalitis with mass-like or multifocal enhancing lesions and negative conventional investigations. Early biopsy or non-invasive sequencing, followed by confirmatory testing and expert-guided combination therapy, represents the most actionable strategy to reduce diagnostic delay.

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Background/objectivesPrimary amoebic meningoencephalitis (PAM) is a rare, fulminant, and often fatal central nervous system infection caused by the opportunistic free-living amoeba Naegleria fowleri. Although Naegleria species are widely present in freshwater and soil worldwide, human disease is associated specifically with pathogenic N. fowleri rather than the many nonpathogenic environmental species, and virulence may vary across N. fowleri isolates. This systematic review aimed to synthesize contemporary global data from 2000 to 2024 to identify recent trends in epidemiology, clinical presentation, diagnosis, treatment, and outcomes.MethodsA systematic literature search was conducted across PubMed, Scopus, and the Cochrane Library, identifying 58 eligible publications encompassing 66 individual cases.ResultsMost reports originated from the United States, India, and China. The median patient age was 14 years, with 78% of cases occurring in males. Annual case reports increased from one per year (2000-2005) to over four per year (2020-2024), reflecting either a true rise in incidence or improved detection. Common presenting symptoms included fever, headache, and altered mental status. Diagnosis was confirmed via polymerase chain reaction (PCR) testing or post-mortem biopsy in nearly one-third of cases. Treatment regimens varied, with amphotericin B and miltefosine being the most frequently used agents. Overall mortality was 83%, with survival strongly associated with early initiation of combination therapy. Pediatric patients had a higher survival rate (22%) compared to adults (7.1%).ConclusionsThe findings highlight the need for heightened clinical awareness, especially in the context of climate-driven ecological changes that may expand N. fowleri's geographic range. This review underscores critical gaps in surveillance and diagnostics and emphasizes the importance of a One Health approach to addressing emerging threats like PAM. Further research into novel therapeutics, rapid diagnostics, and global case reporting systems is urgently needed.

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BackgroundCutaneous leishmaniasis (CL) affects up to 1.2 million people annually, mainly in resource-limited regions. Meglumine antimoniate, the standard treatment, is limited by systemic toxicity, injectable administration, and increasing resistance. Miltefosine, an oral alternative, offers practical advantages, although comparative efficacy and safety data remain inconsistent.ObjectiveTo compare the efficacy and safety of miltefosine versus meglumine antimoniate for New World CL.MethodsThe authors systematically searched PubMed, Embase, Scopus, and the Cochrane Library for randomized controlled trials directly comparing miltefosine and meglumine antimoniate. Risk Ratios (RRs) with 95% Confidence Intervals (95% CIs) were calculated using random-effects models. Heterogeneity was assessed with the I² statistic. Risk of bias was evaluated using the Cochrane RoB-2 tool. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.ResultsEight trials involving 898 patients (502 treated with miltefosine, 396 with meglumine antimoniate) were included. Miltefosine showed significantly higher cure rates at two months (RR = 0.83; 95% CI: 0.71-0.98; I2 = 0%). Differences at six months were not statistically significant. Gastrointestinal side effects were more frequent with miltefosine, whereas hepatic enzyme elevations, arthralgia (RR = 10.08; 95% CI: 2.36-43.12), and fever (RR = 2.98; 95% CI: 1.53-5.80) were more common with meglumine antimoniate.Study limitationsHigh heterogeneity, short follow-up, small sample sizes, and interstudy variability may limit precision.ConclusionMiltefosine shows superior early response and a safer systemic profile. However, the certainty of evidence, as assessed by GRADE, ranged from very low to high across outcomes, and long-term data remain limited, highlighting the need for further high-quality studies with extended follow-up.

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