Meglumina en series terapéuticas de 10 días en niños con leishmaniosis tegumentaria americana / Meglumine therapeutic series of 10 days in children with american tegumentary leishmaniasis

La cátedra de Medicina Tropical de la Universidad Central de Venezuela viene empleando el antimoniato de meglumina en series terapéuticas de 10 días en el tratamiento de leishmaniosis tegumentaria americana, la cual continúa como problema de salud del medio rural venezolano. Se evalúa una experiencia con una dosis de 70 mg/kg/día de meglumina en niños con la enfermendad. A los pacientes con presunción diagnóstica de leishmaniosis tegumentaria americana (clínica y antecedentes epidemiológicos) se les efectuó la prueba de leishmania, la demostración de anticuerpos flurescentes antileishmania y la visualización de amastigotes en frotis teñidos con Giemsa. Los casos identificados ingresaron al Hospital Universitario (Pediatría médica infecciosa), recibieron 70 mg/kg/día de antimoniato de meglumina en series terapéuticas de 10 días con reposo intercalados por el mismo número de días. Se incluyeron 33 niños con la enfermedad, 21 de género femenino (64%) con promedio de edad 7,12 años y predominio de escolar (70%). Del Estado Miranda procedía el 85%, una sola úlcera la tenía el 88%, localizada en miembros inferiores (49%). La Leishmanina y los anticuerpos fluorescentes antileishmania fueron positivos en todos los pacientes y el frotis para amastigotes en 45%. Dos series de antimoniato de meglumina las recibió 91% de los pacientes; una de 10 días 6%. Egresaron con cicatrizaciones de sus procesos ulcerosos y fueron evaluados durante seis meses en la consulta de endemias rurales y no se evidenciaron recaídas. La variedad cutánea localizada de la enfermedad fue la única identificada, el Estado Miranda continúa aportando la mayoría de los pacientes atendidos en medicina tropical. El antimoniato de meglumina en leishmaniosis tegumentaria americana a la dosis de 70 mg/kg/día en series terapéuticas fue tan eficaz como la anterior de 100 mg/kg/día que dejó de administrarse hace ocho años.

The Tropical Medicine Department of the Universidad Central de Venezuela employs the meglumine pentavalent antimonial in series of 10 days of treatment for American Tegumentary Leishmaniosis, which continues being a health problem in the Venezuelan rural areas. We are reporting a clinical experience of treatment in children at a dose of 70 mg/kg/day. Patients with diagnostic suspición of American Tegumentary Leishmaniosis (clinical and epidemiologic antecedents) who attended the Rural Endemics Clinic at the Instituto de Medicina Tropical of the Universidad Central de Venezuela and to the Medical Infectious Pediatrics Service at the Hospital Universitario de Caracas (HUC), were tested for leishmanine, fluorescent antileishmania antibodies and for the presence of amastigotes of the parasite in smear for apposition from the ulcer that were treated by the Giemsa method. Patients hospitalized at the Medical Infectious Pediatric Service (Hospital Universitario de Caracas) received 70 mg/kg/day of meglumine pentavalent antimonial during 10 days, a rest period of 10 days without treatment and, if 20 days after ulcers were unhealed, was administred a new 10 days meglumine pentavalent antimonial series. We included 33 children with the disease with a mean age of 7,12 years, 70% in school age and 30% preschool children, and 21 (64%) were girls. The 85% of patients came from Miranda`s state, 88% had only ulcer and in 49% of them the lesions where localized in the legs. The apposition smear showed Leishmania amastigotes in 45% od cases. One series of treatment was given to 91% of cases, two children received two series and one three. At discharge from the hospital all ulcers were healed and follow-up control for a 6 months period showed no relapses. The cutaneous localized from was the clinical form of presentation in the children studied. The great majority of patients that assits to the Tropical Medicine Institute come from the Miranda`s state area...

Leishmaniosis ¿cuándo hospitalizar? / Leishmaniosis ¿When to Hospitalize?

La leishmaniosis es una enfermedad infecciosa parasitaria, endémica, de distribución mundial, que en Venezuela se presenta como leishmaniosis tegumentaria americana (cutánea localizada, cutáneomucosa y cutáneo difusa) además de la forma visceral (kala azar). La variedad cutánea localizada representa el 90 por ciento de los casos atendidos en la consulta de Endemias Rurales del Instituto de Medicina Tropical y en los Servicios de Pediatría Médica y Enfermedades Infecciosas del Adulto del Hospital Universitario de Caracas, y la mayoría son tratados ambulatoriamente con antimoniato de meglumina. En algunas situaciones clínicas es necesaria la hospitalización. Se describen ocho casos hospitalizados: 1) niña de dos años con leishmaniosis cutánea que había recibido inmunoterapia para la parasitosis; 2) paciente de 59 años con leishmaniosis de la mucosa nasal; 3) paciente de 64 años con úlcera de los chicleros en el pabellón auricular; 4) paciente de 36 años con falla terapéutica a la meglumina, quien había recibido inmunoterapia para leishmaniosis; 5) paciente de 59 años alcohólico, con ulceración extensa de cinco años de evolución; 6) mujer de 83 años con leishmaniosis cutánea en miembros inferiores; 7) paciente con leishmaniosis de la mucosa nasal y SIDA; 8) paciente de 37 años con kala azar. Se analizan las razones para la hospitalización y las dosis de antimoniato de meglumina empleadas para la solución terapéutica

Leishmaniasis is an endemic parasitic infectious disease of worldwide distribution. In Venezuela the main characteristics correspond to american tegumentary leishmaniasis (cutaneous localized, cutaneous-mucous, cutaneous diffuse) and visceral leishmaniasis (kala azar). The localized cutaneous variety represents 90 percent of the cases attended at the ambulatory medical clinic for rural endemic diseases at the Tropical Medicine Institute, Pediatric and Adult services for Infectious Diseases at the Universitary Hospital of Caracas, and these patients are treated with pentavalent antimonials. In some clinical conditions hospitalization is required. We describe eight cases of patients treated under hospitalization. Case 1) a two year old girl with cutaneous leishmaniasis who had received immunotherapy for this parasitic disease; case 2) fifty nine year old female with nasal leishmaniasis; case 3) sixty four year old male with a rubber tapper’s ulcer in the ear; case 4) thirty six year old male with treatment failure to pentavalent antimonials having received immunotherapy for leishmaniasis; case 5) fifty nine year old male alcoholic patient, with extended ulcer of five years evolution; case 6) eighty three year old female with cutaneous leishmanisis in the legs; case 7) thirty three year old male with leishmaniasis of the nasal mucosa and AIDS; case 8) thirty seven year old male with kala azar. We discuss the reasons for hospitalization and the dosage of pentavalent antimonials administered

Utilidad del cefadroxilo en leishmaniosis tegumentaria americana con infecciones piógenas sobreagregadas / Use of cefadroxil for american tegumentary leishmaniosis with intercurrent pyogenic infections

La leishmaniosis tegumentaria americana es un problema de salud en el medio rural venezolano. Las úlceras leishmánicas tienden a infectarse secundariamente por bacterias piógenas. Se evaluaron 41 pacientes con la enfermedad que recibieron cefadroxilo oral previo a la toma de segmentos de piel del borde de las úlceras para la demostración microscópica de Leishmania spp. La mayoría de los pacientes eran adultos masculinos y provenían del medio rural del estado Miranda, con una úlcera única localizada en los miembros inferiores. El diagnóstico inmunoserológico se efectuó por leishmanina y anticuerpos fluorescentes y el de certeza por visualización de amastigotes en frotis coloreados. Los resultados inmunoserológicos fueron positivos en todos los pacientes, mientras que el parásito se observó en 51 por ciento de los frotis coloreados con Giemsa. Una semana postratamiento antimicrobiano, los pacientes presentaban mejoría de las infecciones sobreagregadas y también progreso en la visualización del parásito por disminución de la carga bacteriana. Los pacientes fueron tratados con antimoniato de meglumina intramuscular en series de 10 días, con reposo intermedio. Respondieron adecuadamente, las lesiones cicatrizaron y los nódulos satelitales acompañantes desaparecieron. Se concluye que el cefadroxilo es útil para tratar las infecciones piógenas secundarias asociadas en LTA y aumentar la sensibilidad para observar los parásitos en piel. La leishmaniosis considerada como enfermedad emergente, motiva la búsqueda de alternativas terapéuticas adecuadas

Cutaneous leishmaniosis of the New World (CLNW) is a health problem in rural areas of Venezuela. Patients with muco-cutaneous ulcers tend to present intercurrent infections of the lesions by pyogenic bacteria. After removing skin specimens from the ulcer borders for microscopic demonstration of Leishmania spp amastigotes, forty-one patients with the disease, being treated with cefadroxil per os were studied. Most of the patients came from rural Miranda state, were male adults and had one ulcer on a lower limb. Confirmatory diagnosis was made using the Montenegro test, or Leishmanin immunoserology (IFAT) and demonstration of the presence of parasites in the skin samples. All the patients were positive for the Leishmanin test, while parasites were observed in 51 percent of the skin smears colored by the Giemsa procedure. After a week of treatment with cefadroxil, bacterial infections were reduced and a decrease in bacterial load was also noted when visualizing the parasite from the skin smears. Patients were treated with intramuscular antimony meglumine for 10-day periods with an intervening rest period. All patients responded adequately to the meglumine antileishmania treatment; the lesions healed and accompanying tributary lymph nodes disappeared. Conclusion: Cefadroxil is a suitable antibiotic for treating intercurrent pyogenic infections in cases of tegumentary leishmaniosis. Since leishmaniosis is considered an emerging disease, a search for appropriate, alternative therapies is required

Leishmaniosis tegumentaria americana: efectividad del antimoniato de meglumina en series terapéuticas de 10 días / American tegumentary leishmaniasis: effectiveness of meglumine antimoniate in 10-day treatment series

La leishmaniosis tegumentaria americana es un problema de salud en el medio rural venezolano. La Cátedra de Medicina Tropical (UCV) y el Hospital Universitario de Caracas reciben pacientes con diagnóstico presuntivo, se realiza el diagnóstico de certeza y son tratados ambulatoria u hospitalariamente con antimoniato de meglumina en series terapéuticas de 10 días, a dosis de 3 000 mg/día a 4 500 mg/día. Se evalúan los resultados de 221 pacientes, la mayoría adultos masculinos, con úlcera única en miembros inferiores, procedentes del medio rural del Estado Miranda. Predominó la variedad cutánea localizada, seguida de la cutáneo mucosa con 4 pacientes y cutáneo difusa con 3. Hubo cicatrización de las úlceras y desaparición de los nódulos cutáneos, excepto en 1 paciente (0,3 por ciento) que requirió anfotericina B por falla terapéutica. En el estudio participan estudiantes del curso regular de la cátedra, integrantes del programa: docencia en medicina tropical basada en publicaciones periódicas

American tegumentary leishmaniasis (ATL) is a health problem in the rural areas of Venezuela. Patients are referred to the Tropical Medicine Department (UCV) and to the University Hospital of Caracas with presumptive diagnosis of the disease, are studied to confirm the diagnosis and treated with antimoniate of meglumine in 10 days course at dose of 3 000 mg./day to 4 500 mg./day according to complications as outpatients or hospitalized. We report the results of 221 patients treated, mostly male adults from the rural area of the Miranda state with a sole ulcer in the limbs. Among the clinical presentation the cutaneous-localized form was predominating, followed by the localized muco-cutaneous with 4 and cutaneous-diffuse variety with 3. They responded with healing of the ulcers and disappearance of skin nodules, except one (0.3 percent) who required anfotericine B due to lack of response to meglumine therapy. In this investigation there was the participation of students from the Tropical Medicine course: learning based on periodic publications with students

Cutaneous leishmaniasis imported from Colombia to Northcentral Venezuela: implications for travel advice.

BACKGROUND: Imported leishmaniasis could be defined as any case acquired outside of a defined area in which the diagnosis of leishmaniasis is made. This definition has been used for the diagnosis of disease in a patient who arrives from an endemic area and displays symptoms or seeks medical attention in a nonendemic zone. However, this phenomenon can also occur between two endemic zones. METHODS: We evaluated the epidemiologic features of imported cases of cutaneous leishmaniasis imported from Colombia into Northcentral Venezuela from 2001 to 2006. A total of 29 patients with the clinical diagnosis of cutaneous leishmaniasis arriving from Colombia were evaluated at our referral center. Different diagnostic methods were used to confirm the diagnosis (the Montenegro skin test; an indirect immunofluorescence test and smear of cutaneous lesion). Clinical and epidemiological features of cutaneous leishmaniasis among these patients were evaluated. RESULTS: We identified that most identified patients were male with a mean age of 35 years (age range was 7-64); all cases were from northern departments of Colombia. These patients presented a mean clinical evolution of 3 months. Most patients presented with one cutaneous lesion (17%), which were located mostly in extremities (20%). Of the 29 patients, in 16 (55%) cutaneous leishmaniasis was confirmed by different diagnostic techniques. In 2 patients the diagnosis was made by smear. In the rest, 14 (100%) patients were positive by the Montenegro skin test and 11 (79%) were positive by the indirect immunofluorescence test (79% were positive simultaneously by both tests). DISCUSSION: The identification of imported cutaneous leishmaniasis in our setting becomes important, given the differences in the epidemiology of the disease and the clinical severity of leishmaniasis between both zones (ecological characteristics, circulating Leishmania spp., and population characteristics) and the risk of the mucocutaneous forms of the disease.

American cutaneous leishmaniasis in children and adolescents from Northcentral Venezuela.

American Cutaneous Leishmaniasis (ACL) comprises a broad range of cutaneous manifestations caused by different Leishmania species which may produce severe and chronic sequelae in adults. However, it has been suggested that ACL may show different clinical and epidemiological features in children and adolescents that need to be further elucidated. We evaluated the epidemiological features of ACL in a cohort of pediatric patients from Northcentral Venezuela between years 1997 and 2005. Mean age of patients was 9 years old, with a mean clinical evolution of 3 months. Lesions were located mostly in extremities. Forty patients (93%) were positive by MST, 97.7% by IFAT and 48.8% by smear. MST values tended to be related to patients' age, higher values being recorded in older patients (p=0.153).

Evaluación terapéutica del antimoniato de meglumina en niños con leishmaniasis tegumentaria americana / Therapeutic evaluation of antimonato of meglumin in children with american tegumentaria leishmaniasis

La leishmaniasis tegumentaria americana ocasiona con frecuencia ulceraciones en la piel de los niños del medio rural venezolano y su tratamiento se basa en el uso del antimoniato de meglumina. Evaluar la experiencia con este antimonial a la dosis de 100 mg/kg/día en niños con leishmaniasis, describir su eficacia terapéutica y valorar los efectos adversos. Estudio prospectivo abierto iniciado en 1987. Se concluyeron niños referidos con diagnóstico presuntivo de leishmaniasis (aspecto de las úlceras y procedencia endémica). Se les identificaron anticuerpos antileishmania por inmunofluorescencia indirecta, leishmanina y frotis por opsición de un segmento de las úlceras (teñidos con Giemsa). Se evaluaron las constantes hematológicas, renales y hepáticas antes, durante y después del tratamiento. Se les practicó electrocardiograma y evaluación cardiovascular. Se les administraron 100mg de antimoniato de meglumina(kg/día durante 10 días. Un reposo de 15 días y la repetición de un segundo ciclo. 193 niños concluyeron el estudio 51 por ciento del sexo femenino, 45 por ciento escolares y 27 por ciento preescolares. Del estado Miranda procedía el 61 por ciento de los casos. En miembros inferiores se localizó 55 por ciento de la úlceras. Más de una sola úlcera presentó el 63 por ciento. Efectos adversos: aminotransferasas séricas elevadas 12 por ciento, proteinuria 10 por ciento, cilindruria 5 por ciento, creatinina elevada, artralgias y taquicardias 1,03 por ciento cada una, hematuria 0,5 por ciento. El antimoniato de meglumina fue bien tolerado a la dosis evaluada. Las aminotransferasas séricas y la proteinuria aparecieron al final del primer ciclo, revertieron después del reposo de 15 días y no ameritaron el retiro de los pacientes del estudio. Todos se curaron y fueron evaluados serológicamente durante seis meses