RESUMO
The study of neglected diseases has not received much attention, especially from public and private institutions over the last years, in terms of strong support for developing treatment for these diseases. Support in the form of substantial amounts of private and public investment is greatly needed in this area. Due to the lack of novel drugs for these diseases, nanobiotechnology has appeared as an important new breakthrough for the treatment of neglected diseases. Recently, very few reviews focusing on filiarasis, leishmaniasis, leprosy, malaria, onchocerciasis, schistosomiasis, trypanosomiasis, and tuberculosis, and dengue virus have been published. New developments in nanocarriers have made promising advances in the treatment of several kinds of diseases with less toxicity, high efficacy and improved bioavailability of drugs with extended release and fewer applications. This review deals with the current status of nanobiotechnology in the treatment of neglected diseases and highlights how it provides key tools for exploring new perspectives in the treatment of a wide range of diseases.
Assuntos
Portadores de Fármacos/uso terapêutico , Nanopartículas/uso terapêutico , Doenças Negligenciadas/tratamento farmacológico , Medicina Tropical , Portadores de Fármacos/administração & dosagem , Portadores de Fármacos/efeitos adversos , Portadores de Fármacos/farmacocinética , Humanos , Leishmaniose/tratamento farmacológico , Hanseníase/tratamento farmacológico , Lipossomos/farmacocinética , Lipossomos/uso terapêutico , Malária/tratamento farmacológico , Nanopartículas/administração & dosagem , Nanopartículas/efeitos adversos , Oncocercose/tratamento farmacológico , Esquistossomose/tratamento farmacológico , Tripanossomíase/tratamento farmacológico , Tuberculose/tratamento farmacológicoRESUMO
OBJECTIVE: To assess the quantity and distribution of evidence from randomised controlled trials for the treatment of the major neglected tropical diseases and to identify gaps in the evidence with network analysis. DESIGN: Systematic review and network analysis. DATA SOURCES: Cochrane Central Register of Controlled Trials and PubMed from inception to 31 August 2011. STUDY SELECTION: Randomised controlled trials that examined treatment of 16 neglected tropical diseases or complications thereof published in English, French, Spanish, Portuguese, German, or Dutch. RESULTS: We identified 971 eligible randomised trials. Leishmaniasis (184 trials, 23,039 participants) and geohelminth infections; 160 trials, 46,887 participants) were the most studied, while dracunculiasis (nine trials, 798 participants) and Buruli ulcer (five trials, 337 participants) were least studied. Relative to its global burden of disease, lymphatic filariasis had the fewest trials and participants. Only 11% of trials were industry funded. Either a single trial or trials with fewer than 100 participants comprised the randomised evidence for first or second line treatments for Buruli ulcer, human African trypanosomiasis, American trypanosomiasis, cysticercosis, rabies, echinococcosis, New World cutaneous leishmaniasis, and each of the foodborne trematode infections. Among the 10 disease categories with more than 40 trials, five lacked sufficient head to head comparisons between first or second line treatments. CONCLUSIONS: There is considerable variation in the amount of evidence from randomised controlled trials for each of the 16 major neglected tropical diseases. Even in diseases with substantial evidence, such as leishmaniasis and geohelminth infections, some recommended treatments have limited supporting data and lack head to head comparisons.
Assuntos
Doenças Negligenciadas/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Projetos de Pesquisa , Anti-Infecciosos/uso terapêutico , Úlcera de Buruli/tratamento farmacológico , Dengue/tratamento farmacológico , Dracunculíase/tratamento farmacológico , Equinococose/tratamento farmacológico , Filariose Linfática/tratamento farmacológico , Helmintíase/tratamento farmacológico , Humanos , Leishmaniose Mucocutânea/tratamento farmacológico , Hanseníase/tratamento farmacológico , Estudos Multicêntricos como Assunto , Raiva/tratamento farmacológico , Apoio à Pesquisa como Assunto , Esquistossomose/tratamento farmacológico , Estrongiloidíase/tratamento farmacológico , Tracoma/tratamento farmacológico , Infecções por Trematódeos/tratamento farmacológico , Medicina Tropical , Tripanossomíase/tratamento farmacológicoRESUMO
CONTEXT: The neglected tropical diseases include 13 conditions that occur in areas of extreme poverty and are poverty promoting. The neglected tropical diseases produce a disease burden almost as great as that associated with human immunodeficiency virus/AIDS, tuberculosis, or malaria, yet are virtually unknown by health care workers in North America, because they occur almost exclusively in the poorest regions of the world. Seven of the most prevalent diseases have existing oral drug treatments. Identifying treatments that are effective against more than 1 disease could facilitate efficient and inexpensive treatment. OBJECTIVES: To systematically review the evidence for drug treatments and to increase awareness that neglected tropical diseases exist and that treatments are available. DATA SOURCES AND STUDY SELECTION: Using a MEDLINE search (1966 through June 2007), randomized controlled trials (RCTs) were reviewed that examined simultaneous treatment of 2 or more of the 7 most prevalent neglected tropical diseases using oral drug therapy. DATA SYNTHESIS: Twenty-nine RCTs were identified, of which 3 targeted 4 diseases simultaneously, 20 targeted 3 diseases, and 6 targeted 2 diseases. Trials were published between 1972 and 2005 and baseline prevalence of individual diseases varied among RCTs. Albendazole plus diethylcarbamazine significantly reduced prevalence of elephantiasis (16.7% to 5.3%), hookworm (10.3% to 1.9%), roundworm (34.5% to 2.3%), and whipworm (55.5% to 40.3%). Albendazole plus ivermectin significantly reduced prevalence of elephantiasis (12.6% to 4.6%), hookworm (7.8% to 0%), roundworm (33.5% to 6.1%), and whipworm (42.7% to 8.9%). Levamisole plus mebendazole significantly reduced prevalence of hookworm (94.0% to 71.8%), roundworm (62.0% to 1.4%), and whipworm (93.1% to 74.5%). Pyrantel-oxantel significantly reduced hookworm (93.4% to 85.2%), roundworm (22.8% to 1.4%), and whipworm (86.8% to 59.5%), while albendazole alone significantly reduced prevalence of hookworm (8.1% to 1.3%), roundworm (28.4% to 0.9%), and whipworm (51.9% to 31.9%). No RCT examined treatment of river blindness or trachoma as part of an intervention to target 2 or more neglected tropical diseases. Adverse events were generally inadequately reported. CONCLUSIONS: At least 2 of the most prevalent neglected tropical diseases can be treated simultaneously with existing oral drug treatments, facilitating effective and efficient treatment. Increasing awareness about neglected tropical diseases, their global impact, and the availability of oral drug treatments is an essential step in controlling these diseases.
Assuntos
Antibacterianos , Antiparasitários , Países em Desenvolvimento , Tratamento Farmacológico/economia , Doenças Parasitárias/tratamento farmacológico , Pobreza , Medicina Tropical , Administração Oral , Antibacterianos/administração & dosagem , Antibacterianos/economia , Antibacterianos/provisão & distribuição , Antiparasitários/administração & dosagem , Antiparasitários/economia , Antiparasitários/provisão & distribuição , Ascaríase/tratamento farmacológico , Doença de Chagas/tratamento farmacológico , Dracunculíase/tratamento farmacológico , Filariose Linfática/tratamento farmacológico , Infecções por Uncinaria/tratamento farmacológico , Humanos , Leishmaniose/tratamento farmacológico , Hanseníase/tratamento farmacológico , Oncocercose Ocular/tratamento farmacológico , Esquistossomose/tratamento farmacológico , Tracoma/tratamento farmacológico , Tricuríase/tratamento farmacológico , Medicina Tropical/economia , Tripanossomíase/tratamento farmacológicoRESUMO
Patologías por protozoarios: enfermedad de chagas; paludismo; leishmaniasis. Patologías por helmintos: hidatidosis; uncinariasis. Patologías por bacterias: brucelosis; lepra. Patologías por hongos: paracoccidioidomicosis; histoplasmosis. Patologías por virus: fiebre hemorrágica argentina. Patologías por intoxicaciones: hidroarsenicismo crónico regional endémico. Patologías exóticas conminantes: cólera; dengue; esquistosomiasis
Assuntos
Brucelose/diagnóstico , Cólera/diagnóstico , Dengue/diagnóstico , Doença de Chagas/diagnóstico , Doenças Transmissíveis/diagnóstico , Febre Hemorrágica Americana/diagnóstico , Hanseníase/diagnóstico , Helmintíase/diagnóstico , Histoplasmose/diagnóstico , Paracoccidioidomicose/diagnóstico , Arsenicais/intoxicação , Arsenicais/toxicidade , Brucelose/epidemiologia , Brucelose/tratamento farmacológico , Cólera/epidemiologia , Cólera/tratamento farmacológico , Dengue/epidemiologia , Dengue/terapia , Doença de Chagas/epidemiologia , Doença de Chagas/tratamento farmacológico , Esquistossomose/diagnóstico , Esquistossomose/epidemiologia , Esquistossomose/tratamento farmacológico , Febre Hemorrágica Americana/epidemiologia , Febre Hemorrágica Americana/terapia , Hanseníase/epidemiologia , Hanseníase/tratamento farmacológico , Helmintíase/epidemiologia , Helmintíase/tratamento farmacológico , Histoplasmose/epidemiologia , Histoplasmose/tratamento farmacológico , Infecções por Protozoários/diagnóstico , Infecções por Protozoários/epidemiologia , Infecções por Protozoários/tratamento farmacológico , Paracoccidioidomicose/epidemiologia , Paracoccidioidomicose/tratamento farmacológico , Poluição Química da Água/efeitos adversosRESUMO
Patologías por protozoarios: enfermedad de chagas; paludismo; leishmaniasis. Patologías por helmintos: hidatidosis; uncinariasis. Patologías por bacterias: brucelosis; lepra. Patologías por hongos: paracoccidioidomicosis; histoplasmosis. Patologías por virus: fiebre hemorrágica argentina. Patologías por intoxicaciones: hidroarsenicismo crónico regional endémico. Patologías exóticas conminantes: cólera; dengue; esquistosomiasis
Assuntos
Doenças Transmissíveis/diagnóstico , Doença de Chagas/diagnóstico , Helmintíase/diagnóstico , Hanseníase/diagnóstico , Brucelose/diagnóstico , Paracoccidioidomicose/diagnóstico , Histoplasmose/diagnóstico , Febre Hemorrágica Americana/diagnóstico , Cólera/diagnóstico , Dengue/diagnóstico , Doença de Chagas/epidemiologia , Doença de Chagas/tratamento farmacológico , Infecções por Protozoários/diagnóstico , Infecções por Protozoários/epidemiologia , Infecções por Protozoários/tratamento farmacológico , Helmintíase/epidemiologia , Helmintíase/tratamento farmacológico , Hanseníase/epidemiologia , Hanseníase/tratamento farmacológico , Brucelose/epidemiologia , Brucelose/tratamento farmacológico , Paracoccidioidomicose/epidemiologia , Paracoccidioidomicose/tratamento farmacológico , Histoplasmose/epidemiologia , Histoplasmose/tratamento farmacológico , Febre Hemorrágica Americana/epidemiologia , Febre Hemorrágica Americana/terapia , Arsenicais/intoxicação , Arsenicais/toxicidade , Poluição Química da Água/efeitos adversos , Cólera/epidemiologia , Cólera/tratamento farmacológico , Dengue/epidemiologia , Dengue/terapia , Esquistossomose/diagnóstico , Esquistossomose/epidemiologia , Esquistossomose/tratamento farmacológicoRESUMO
Schistosoma mekongi, a parasite of the dog which is endemic in small foci along the Mikong river, is rarely seen in Europe. A case of schistosomiasis caused by S mekongi was recently seen in France, in a native of Laos who had been living in Thailand. He was admitted for treatment of previous diagnosed tuberculoid leprosy but was found to have hepatosplenomegaly, with a high eosinophil count and high bilirubin concentrations. Serological examination suggested schistosomiasis, but there were no parasites in the urine and the rectal mucosa looked normal on endoscopy. Nevertheless, rectal biopsy showed schistosomal proctitis and many ova of S mekongi. Two courses of praziquantel cleared the ova from his rectal mucosa. Although serological examination using S mansoni antigen suggested schistosomiasis, only biopsy of normal looking rectal mucosa allowed the diagnosis to established.