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S.F. nonprofit helps develop low-cost cure for black fever
- Sabin Russell, Chronicle Medical Writer
Tuesday, November 9, 2004


An international team of researchers, backed by a unique San Francisco nonprofit corporation, has found that repeated injections of a low- cost antibiotic can cure black fever, a parasitic disease that kills 200,000 people a year in poor countries.

Black fever, also known as visceral leishmaniasis (LEESH- man-EYE-a-sis), is caused by a microscopic parasite transmitted by the bite of a sand fly.

More than 1.5 million people are infected, mostly in India, Bangladesh, Nepal, Sudan and Brazil. Among parasitic diseases, it is second only to malaria as a global killer.

Once the leishmaniasis parasite takes hold in the bloodstream, it can infiltrate vital organs, and it is particularly destructive to the liver and spleen. Patients suffer fever, weight loss and anemia. Left untreated, the disease is usually fatal.

Currently, the most effective cure for the illness is an intravenous drip of amphotericin B, an antifungal medication costing $200 per treatment. But at a meeting Monday in Miami of the American Society of Tropical Medicine and Hygiene, results of a study conducted in Bihar, India, showed that the disease can also be cured with repeated injections of the antibiotic paromomycin for about $10.

"We believe this drug will be the safest, most effective and affordable medicine for visceral leishmaniasis when it is approved,'' said Victoria Hale, founder and chief executive of the Institute for OneWorld Health, a San Francisco nonprofit company that is guiding the treatment through clinical trials.

The study of black fever patients in Bihar yielded cure rates of 94 percent for paromomycin, compared with 97 percent for amphotericin B. However, the costly antifungal drug caused adverse side effects in two-thirds of those who took it, compared with only 8 percent of patients on the antibiotic.

Amphotericin B can cause side effects ranging from fever and nausea to kidney damage and inflammation of blood vessels. Current formulations have reduced the severity of those side effects but have made the drug too costly for the developing world, according to OneWorld spokeswoman Joanne Hasegawa.

Paromomycin was developed in the 1950s as a broad-spectrum antibiotic, and patents for it are long-expired. In oral form, it is still used to treat intestinal parasites.

OneWorld has helped develop an injectable version. Patients receive the drug in a series of 21 daily injections in the buttocks. They do not need to be hospitalized, a typical requirement for more expensive, intravenous treatments.

The mission of OneWorld is to find cast-off drugs that may find new uses in poor countries, a niche that offers no financial incentives for big pharmaceutical companies.

"The pharmaceutical industry is so productive that there is a lot lying fallow on their shelves," Hasegawa said. "We try to take the best out there and apply it to the diseases that are our focus.''

OneWorld hopes to win approval from India's drug regulators in 2005.

The drug is manufactured by IDA Solutions, a Dutch drug company that also works as a nonprofit provider of medicines to poor countries. IDA and OneWorld are arranging for paromomycin to be made by Gland Pharma Ltd. of Hyderabad, India, a firm that specializes in production of injectable pharmaceuticals.

OneWorld is financing the development of the new leishmaniasis treatment with a $12 million grant for the Bill & Melinda Gates Foundation.

E-mail Sabin Russell at srussell@sfchronicle.com.

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