RESUMO
Lobomycosis, also referred to as lacaziosis, is an endemic cutaneous and subcutaneous fungal disease that mainly affects Amazonian forest dwellers in Brazil. There is no disease control program in place in Brazil, and antifungal therapy failures are common, and the therapy is inaccessible to most patients. We performed a randomized, unblinded clinical trial testing the cure rate of multiple drug therapy (MDT) for leprosy with surgical excision, with or without itraconazole. A control arm consisted of patients who did not adhere to either therapeutic regimens but continued to be followed up. Multiple drug therapy consisted of monthly supervised doses of 600 mg rifampicin, 300 mg clofazimine, and 100 mg dapsone, in addition to daily doses of 50 mg clofazimine and 100 mg dapsone. The patients in the MDT plus itraconazole arm also received itraconazole 100 mg twice daily. We followed up 54 patients from the MDT group and 26 patients from the MDT plus itraconazole group for an average of 4 years and 9 months. The 23 controls were followed up for 6 months on average. The following endpoints were observed: 1) unchanged (no apparent improvement), 2) improved (reduction in lesion size and/or pruritus), and 3) cured (complete remission of the lesions, no viable fungi, and no relapse for 2 years after the end of the drug treatment). The results indicated a significantly greater likelihood of cure associated with the use of multidrug therapy for leprosy with or without itraconazole when compared with the control group. The addition of itraconazole to MDT was not associated with improved outcomes, suggesting that MDT alone is effective(AU).
Assuntos
Humanos , Masculino , Feminino , Quimioterapia Combinada , Lobomicose/tratamento farmacológico , Rifampina/uso terapêutico , Clofazimina/uso terapêutico , Itraconazol/uso terapêutico , Dapsona/uso terapêutico , Hanseníase/tratamento farmacológicoRESUMO
Lobomycosis, also referred to as lacaziosis, is an endemic cutaneous and subcutaneous fungal disease that mainly affects Amazonian forest dwellers in Brazil. There is no disease control program in place in Brazil, and antifungal therapy failures are common, and the therapy is inaccessible to most patients. We performed a randomized, unblinded clinical trial testing the cure rate of multiple drug therapy (MDT) for leprosy with surgical excision, with or without itraconazole. A control arm consisted of patients who did not adhere to either therapeutic regimens but continued to be followed up. Multiple drug therapy consisted of monthly supervised doses of 600 mg rifampicin, 300 mg clofazimine, and 100 mg dapsone, in addition to daily doses of 50 mg clofazimine and 100 mg dapsone. The patients in the MDT plus itraconazole arm also received itraconazole 100 mg twice daily. We followed up 54 patients from the MDT group and 26 patients from the MDT plus itraconazole group for an average of 4 years and 9 months. The 23 controls were followed up for 6 months on average. The following endpoints were observed: 1) unchanged (no apparent improvement), 2) improved (reduction in lesion size and/or pruritus), and 3) cured (complete remission of the lesions, no viable fungi, and no relapse for 2 years after the end of the drug treatment). The results indicated a significantly greater likelihood of cure associated with the use of multidrug therapy for leprosy with or without itraconazole when compared with the control group. The addition of itraconazole to MDT was not associated with improved outcomes, suggesting that MDT alone is effective.
Assuntos
Quimioterapia Combinada/métodos , Lacazia/efeitos dos fármacos , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Lobomicose/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Brasil/epidemiologia , Quimioterapia Combinada/estatística & dados numéricos , Feminino , Humanos , Lacazia/patogenicidade , Hanseníase/epidemiologia , Lobomicose/epidemiologia , Masculino , Pessoa de Meia-Idade , Pele/microbiologia , Pele/patologia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Foram estudadas as alteraçöes oculares em 63 pacientes internos no Hospital Colônia Araújo (Rio Branco-Acre). Um terço dos pacientes apresentou acuidade visual menor do que 20/200. As alteraçöes dos anexos oculares mais comuns foram: triquíase, madarose de supercílios e epífora. Ao passo que os achados oculares mais freqüentes foram: catarata, anestesia,corneana e pterígio