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1.
Medicine (Baltimore) ; 99(20): e20198, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443341

RESUMO

RATIONALE: Metronidazole is widely used for treating infection of anaerobic bacteria and protozoa. Metronidazole is generally well tolerated, although metronidazole-associated peripheral neuropathy (PN) and metronidazole-induced encephalopathy (MIE) have been reported as rare side effects. The most common sites of MIE involve the bilateral dentate nucleus of the cerebellum. Herein, we present a rare case of MIE with isolated corpus callosum involvement, with concomitant metronidazole-associated PN. PATIENT CONCERNS: A middle-aged man with ulcerative colitis was diagnosed with amoebic dysentery because of unhygienic eating. After receiving metronidazole (1.8 g/d, cumulative dose 61.2 g) for >1 month, he started to complain of continuous paresthesia of the limbs, and intermittent speech problems. Magnetic resonance imaging demonstrated an isolated lesion in the splenium of the corpus callosum. DIAGNOSIS: A diagnosis of reversible splenial lesion syndrome and PN was made. Given the patient's medical history, MIE and metronidazole-associated PN were considered. INTERVENTIONS: Metronidazole was stopped. Mecobalamine and vitamin B1 were used for adjuvant treatment. OUTCOMES: At 1.5 months after stopping metronidazole, his symptoms of numbness and hyperesthesia had not improved, although he felt less ill. The isolated lesion disappeared on follow-up magnetic resonance imaging. At 6 months later, the hyperesthesia symptoms remained, and he was unable to resume his previous work. CONCLUSIONS: Physicians should consider MIE in their differentials for reversible splenial lesion syndrome when encountering a patient with a history of metronidazole medication and symptoms of encephalopathy, especially with concomitant PN. Early identification of this metronidazole-related complication and early cessation of the drug are essential for treatment.


Assuntos
Antiprotozoários/efeitos adversos , Encefalopatias/induzido quimicamente , Disenteria Amebiana/tratamento farmacológico , Metronidazol/efeitos adversos , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Adulto , Idoso , Encefalopatias/diagnóstico , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/efeitos dos fármacos , Corpo Caloso/patologia , Disenteria Amebiana/complicações , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tiamina/administração & dosagem , Tiamina/uso terapêutico , Resultado do Tratamento , Vitamina B 12/administração & dosagem , Vitamina B 12/análogos & derivados , Vitamina B 12/uso terapêutico , Complexo Vitamínico B/administração & dosagem , Complexo Vitamínico B/uso terapêutico , Suspensão de Tratamento
2.
Hautarzt ; 71(6): 437-442, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32394080

RESUMO

Here we describe two complicated cases of complex Old World cutaneous Leishmaniasis due to L. infantum and L. aethiopica. Both of our patients infected with the Leishmania parasite presented with a completely different clinical picture, course of disease, and treatment response. Clinical healing was achieved after multiple courses of treatment with a variety of different antileishmanial drugs. Nephrotoxity was a limiting side effect.


Assuntos
Leishmania infantum/isolamento & purificação , Leishmania/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/uso terapêutico , Antiprotozoários/efeitos adversos , Antiprotozoários/uso terapêutico , Progressão da Doença , Humanos , Leishmania/classificação
3.
Trop Doct ; 50(2): 165-166, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32019474

RESUMO

Related neurological adverse effects to metronidazole are rarely encountered in clinical practice despite its wide use as an antibacterial or antiparasitic agent. The neurotoxicity is not dose-dependent and is fully reversible with discontinuation of the drug. We describe a young man who was receiving metronidazole for an amoebic liver abscess and developed encephalopathy and seizures. Brain magnetic resonance imaging showed characteristic bilateral symmetrical cerebellar dentate hyperintensities.


Assuntos
Antiprotozoários/efeitos adversos , Abscesso Hepático Amebiano/tratamento farmacológico , Metronidazol/efeitos adversos , Síndromes Neurotóxicas/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Síndromes Neurotóxicas/diagnóstico por imagem , Convulsões/diagnóstico por imagem , Convulsões/etiologia , Adulto Jovem
4.
Nihon Shokakibyo Gakkai Zasshi ; 117(1): 72-77, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-31941859

RESUMO

Peripheral neuropathy reportedly develops after a long period of metronidazole administration. Here, we report a case of amoebic colitis in which peripheral neuropathy occurred approximately 24 hours after administering metronidazole. A 76-year-old man presented with mucous and bloody stool. Initially, lower gastrointestinal endoscopy and stool analysis confirmed the occurrence of amoebic colitis, and metronidazole was then intravenously administered. The following day, however, the patient experienced a diminished sensation in a glove-and-stocking distribution in his extremities, followed by bilateral burning foot pain. After the withdrawal of metronidazole, the symptoms improved and finally disappeared 3 months later.


Assuntos
Antiprotozoários/efeitos adversos , Disenteria Amebiana , Metronidazol/efeitos adversos , Doenças do Sistema Nervoso Periférico , Idoso , Antiprotozoários/uso terapêutico , Hemorragia Gastrointestinal , Humanos , Masculino , Metronidazol/uso terapêutico
5.
J Vet Med Sci ; 82(2): 184-187, 2020 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-31904004

RESUMO

Toxoplasma gondii can cause severe encephalitis in immunocompromised patients. Although pyrimethamine and sulphadiazine have been standard therapeutic agents for the treatment of acute toxoplasmosis, they have toxic side effects. Therefore, there is a need to identify new drugs that are less toxic. Some traditional Chinese medicines (TCMs) have shown good efficacy in controlling T. gondii replication in mouse models. Here, we screened a natural product library comprising TCMs with the aim of identifying compounds and extracts with anti-toxoplasmosis activities. We found several hit compounds and extracts that could be candidates for new drugs against T. gondii infection.


Assuntos
Medicamentos de Ervas Chinesas/efeitos adversos , Medicamentos de Ervas Chinesas/farmacologia , Toxoplasma/efeitos dos fármacos , Animais , Antiprotozoários/efeitos adversos , Antiprotozoários/farmacologia , Linhagem Celular , Chlorocebus aethiops , Humanos , Toxoplasma/crescimento & desenvolvimento , Toxoplasmose/tratamento farmacológico , Células Vero
6.
Am J Trop Med Hyg ; 102(2): 274-279, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31820708

RESUMO

Cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL) are endemic diseases in America, especially in some countries such as Colombia. Among the therapeutic options is amphotericin B (AB). Nevertheless, its lipid-associated formulations have better safety profiles and effectiveness in other diseases, so far with no comparative studies in CL or MCL. We conducted a retrospective descriptive study describing the effectiveness and adverse effects of AB deoxycholate (ABD), AB colloidal dispersion (ABCD), and liposomal AB (LAB) as third-line treatments for CL and MCL. The effectiveness of LAB (88.5%) was greater than those of ABCD (66.6%) and ABD (80.8%). There were also fewer adverse effects in the LAB group (46.2%) than in the ABD (96.1%) and ABCD (80.9%) groups. LAB is an alternative for the treatment of CL and MCL in patients with therapeutic failure to first- and second-line drugs; findings suggest it might be less toxic and more effective than ABD and ABCD.


Assuntos
Anfotericina B/efeitos adversos , Anfotericina B/uso terapêutico , Ácido Desoxicólico/uso terapêutico , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Mucocutânea/tratamento farmacológico , Antiprotozoários/efeitos adversos , Antiprotozoários/uso terapêutico , Coloides , Colômbia/epidemiologia , Ácido Desoxicólico/efeitos adversos , Combinação de Medicamentos , Humanos , Leishmaniose Cutânea/epidemiologia , Leishmaniose Mucocutânea/epidemiologia , Estudos Retrospectivos
7.
Trop Doct ; 50(1): 37-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31610724

RESUMO

A 12-week course of miltefosine (MF) is recommended in India for the treatment of post-kala-azar dermal leishmaniasis (PKDL). We report a case series of four patients with PKDL, across three districts of Bihar state, who developed eye complications during treatment. They presented with acute scleritis and corneal infiltration with or without corneal ulceration. One patient solely with corneal infiltration recovered completely. The three others with corneal ulceration healed with corneal opacificity. One patient with bilateral eye involvement underwent corneal transplantation to prevent blindness. All adverse events were graded as certain using the World Health Organization-Uppsala Monitoring Centre causality assessment scale. There is need to counsel patients regarding possible adverse ocular events during MF treatment, to expand pharmacovigilance to all primary health centres in kala-azar endemic areas, and to update drug safety information considering the emerging evidence.


Assuntos
Antiprotozoários/efeitos adversos , Oftalmopatias/induzido quimicamente , Leishmaniose Visceral/tratamento farmacológico , Fosforilcolina/análogos & derivados , Adulto , Antiprotozoários/uso terapêutico , Criança , Oftalmopatias/patologia , Oftalmopatias/fisiopatologia , Oftalmopatias/terapia , Feminino , Humanos , Índia/epidemiologia , Leishmaniose Visceral/epidemiologia , Masculino , Pessoa de Meia-Idade , Fosforilcolina/efeitos adversos , Fosforilcolina/uso terapêutico , Resultado do Tratamento , Adulto Jovem
8.
J Infect Dis ; 221(4): 608-617, 2020 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-31854451

RESUMO

BACKGROUND: No satisfactory canonical treatment is available for post-kala-azar dermal leishmaniasis (PKDL), clinical sequela of visceral leishmaniasis. Confined treatment options and substantial increase in relapse rate after miltefosine (MIL) treatment warrant the need to adapt resilient combination therapies. In this study, we assessed the safety and efficacy of combination therapy using liposomal amphotericin B (LAmB) and MIL for treating PKDL. METHODS: Thirty-two PKDL patients, confirmed by microscopy or quantitative polymerase chain reaction (qPCR), were included in the study. An equal number of cases (n = 16) were put on MIL monotherapy (100 mg/day for 90 days) or MIL and LAmB combination for 45 days (3 injections of LAmB, 5 mg/kg body weight, and 100 mg/day MIL). Parasite load in slit aspirate was monitored using qPCR. RESULTS: Patients treated with combination therapy demonstrated a rapid decline in parasite load and achieved 100% cure, with no reports of relapse. Those treated with MIL monotherapy attained clinical cure with a gradual decrease in parasite load; however, 25% relapsed within 18 months of follow-up. CONCLUSIONS: Liposomal amphotericin B and MIL combination for treating PKDL is efficacious and safe, with high tolerability. Furthermore, this study established the utility of minimally invasive slit aspirate method for monitoring of parasite load and assessment of cure in PKDL.


Assuntos
Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmania donovani/genética , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Visceral/tratamento farmacológico , Fosforilcolina/análogos & derivados , Adolescente , Adulto , Anfotericina B/efeitos adversos , Antiprotozoários/efeitos adversos , Criança , DNA de Protozoário/genética , Quimioterapia Combinada , Feminino , Humanos , Leishmaniose Cutânea/parasitologia , Leishmaniose Visceral/parasitologia , Lipossomos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Carga Parasitária , Fosforilcolina/efeitos adversos , Fosforilcolina/uso terapêutico , Reação em Cadeia da Polimerase em Tempo Real , Recidiva , Resultado do Tratamento , Adulto Jovem
9.
Res Vet Sci ; 126: 131-138, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31491669

RESUMO

This study examines correlations among serum proteins, clinical score, body weight and kidney function biomarkers after a standard treatment course (meglumine antimoniate plus allopurinol) in twelve Canine leishmaniosis (CanL) patients at the three times points pre treatment, after treatment and after the end of treatment. The laboratory variables measured were those used for the follow-up of sick dogs along with biomarkers of kidney function: glomerular filtration rate (GFR), creatinine (Cr), urea, calcium, inorganic phosphorus, urine specific gravity (USG) and urine protein to creatinine ratio (UPC). Arterial blood pressure (systolic blood pressure, SBP), clinical score (CS) and weight were also monitored over the study period. At Tp0, GFR was within the normal range in most dogs. Hyperfiltration was detected in three patients and hypofiltration in one. In dogs showing hyperfiltration, this factor remained in the non-azotemic range over the whole study period. After treatment normal filtration values were recovered. Meglumine antimoniate did not modify GFR or USG. A significant reduction in UPC was recorded. In all dogs, clinical scores improved. Negative correlation was found between GFR and Cr, UPC and albumin (Alb) and CS and Alb, while positive correlation was detected between UPC and total globulins (GlobT), CS and GlobT, UPC and total solids (TS), SBP and CS and SBP and UPC. Our findings indicate no impacts on kidney function of the treatment of CanL with meglumine antimoniate, as no effects were produced on GFR or USG. Treatment was effective and found to reduce UPC which could suggest improved glomerular injury.


Assuntos
Antiprotozoários/uso terapêutico , Doenças do Cão/tratamento farmacológico , Nefropatias/veterinária , Leishmaniose Visceral/veterinária , Antimoniato de Meglumina/uso terapêutico , Alopurinol/administração & dosagem , Animais , Antiprotozoários/efeitos adversos , Biomarcadores , Creatinina/urina , Cães , Feminino , Taxa de Filtração Glomerular , Nefropatias/induzido quimicamente , Leishmania infantum , Leishmaniose Visceral/tratamento farmacológico , Masculino , Antimoniato de Meglumina/administração & dosagem
10.
An Bras Dermatol ; 94(3): 355-357, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365669

RESUMO

Pentavalent antimonials are the first-line drug treatment for American tegumentary leishmaniasis. We report on a patient with chronic renal failure on hemodialysis who presented with cutaneous lesions of leishmaniasis for four months. The patient was treated with intravenous meglumine under strict nephrological surveillance, but cardiotoxicity, acute pancreatitis, pancytopenia, and cardiogenic shock developed rapidly. Deficient renal clearance of meglumine antimoniate can result in severe toxicity, as observed in this case. These side effects are related to cumulative plasma levels of the drug. Therefore, second-line drugs like amphotericin B are a better choice for patients on dialysis.


Assuntos
Antiprotozoários/efeitos adversos , Leishmaniose Cutânea/complicações , Leishmaniose Cutânea/tratamento farmacológico , Antimoniato de Meglumina/efeitos adversos , Insuficiência Renal Crônica/complicações , Adulto , Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Brasil , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Leishmaniose Cutânea/patologia , Masculino , Diálise Renal
11.
Postgrad Med ; 131(8): 589-596, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31399001

RESUMO

No new drugs for treatment of toxoplasmosis have been approved in over 60 years, despite the burden of toxoplasmosis on human society. The small selection of effective drugs is limited by important side effects, often limiting patient use. This perspective highlights promising late-stage drug candidates in the treatment of toxoplasmosis. Presently, drugs target the tachyzoite form of the parasite Toxoplasma gondii responsible for the acute infection but do not eradicate the tissue cyst form underlying chronic infection. Pyrimethamine - the first-line and only approved drug for treatment of toxoplasmosis in the United States - inhibits parasite DNA synthesis by inhibiting dihydrofolate reductase (DHFR). Two novel DHFR inhibitors with improved potency and selectivity for parasite DHFR over human DHFR are in clinical-stage development. One of the most advanced and promising therapeutic targets, demonstrating potential to treat both acute and chronic toxoplasmosis, is the calcium-dependent protein kinase 1 (CDPK1) which plays an essential role in the intracellular replicative cycle of the parasite, and has no direct mammalian homolog. Two CDPK1 inhibitor programs have identified potent and selective lead series, demonstrating acceptable systemic and CNS exposure, and in vivo efficacy in animal models of acute and chronic infection. Physicians need a better arsenal of parasiticidal drugs for the treatment of toxoplasmosis, particularly those active against tissue cysts.


Assuntos
Antiprotozoários/uso terapêutico , Proteínas de Ligação ao Cálcio/antagonistas & inibidores , Antagonistas do Ácido Fólico/uso terapêutico , Proteínas de Protozoários/antagonistas & inibidores , Toxoplasmose/tratamento farmacológico , Doença Aguda , Animais , Antiprotozoários/efeitos adversos , Antiprotozoários/farmacologia , Doença Crônica , Antagonistas do Ácido Fólico/efeitos adversos , Antagonistas do Ácido Fólico/farmacologia , Humanos , Proteínas Quinases , Pirimetamina/uso terapêutico , Tetra-Hidrofolato Desidrogenase , Toxoplasma , Estados Unidos
12.
Nat Commun ; 10(1): 2816, 2019 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-31249291

RESUMO

Cryptosporidiosis is a leading cause of life-threatening diarrhea in young children and causes chronic diarrhea in AIDS patients, but the only approved treatment is ineffective in malnourished children and immunocompromised people. We here use a drug repositioning strategy and identify a promising anticryptosporidial drug candidate. Screening a library of benzoxaboroles comprised of analogs to four antiprotozoal chemical scaffolds under pre-clinical development for neglected tropical diseases for Cryptosporidium growth inhibitors identifies the 6-carboxamide benzoxaborole AN7973. AN7973 blocks intracellular parasite development, appears to be parasiticidal, and potently inhibits the two Cryptosporidium species most relevant to human health, C. parvum and C. hominis. It is efficacious in murine models of both acute and established infection, and in a neonatal dairy calf model of cryptosporidiosis. AN7973 also possesses favorable safety, stability, and PK parameters, and therefore, is an exciting drug candidate for treating cryptosporidiosis.


Assuntos
Amidas/administração & dosagem , Antiprotozoários/administração & dosagem , Compostos de Boro/administração & dosagem , Criptosporidiose/tratamento farmacológico , Isoxazóis/administração & dosagem , Amidas/efeitos adversos , Amidas/química , Animais , Antiprotozoários/efeitos adversos , Antiprotozoários/química , Compostos de Boro/efeitos adversos , Compostos de Boro/química , Criptosporidiose/parasitologia , Cryptosporidium/efeitos dos fármacos , Cryptosporidium/crescimento & desenvolvimento , Avaliação Pré-Clínica de Medicamentos , Feminino , Humanos , Isoxazóis/efeitos adversos , Isoxazóis/química , Masculino , Camundongos , Ratos
14.
PLoS One ; 14(6): e0218786, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31242231

RESUMO

BACKGROUND: Liposomal amphotericin B (L-AMB) has been used for mucosal leishmaniasis (ML), but comparative studies on L-AMB and other drugs used for the treatment of ML have not been conducted. The present study aimed to evaluate the outcome of patients with ML who were treated with L-AMB. METHODS: This is a 15-year retrospective study of Brazilian patients with a confirmed diagnosis of ML. The therapeutic options for the treatment of ML consisted of L-AMB, amphotericin B lipid complex (ABLC), deoxycholate amphotericin B (d-AMB), itraconazole, antimonial pentavalent, or pentamidine. Healing, cure rate and adverse effects (AEs) associated with the drugs used to treat this condition were analyzed. RESULTS: In 71 patients, a total of 105 treatments were evaluated. The outcome of the treatment with each drug was compared, and results showed that L-AMB was superior to other therapeutic regimens (P = 0.001; odds ratio [OR] = 4.84; 95% confidence interval [CI] = 1.78-13.17). d-AMB had worse AEs than other treatment regimens (P = 0.001, OR = 0.09; 95% CI = 0.09-0.43). Approximately 66% of the patients presented with AEs during ML treatment. Although L-AMB was less nephrotoxic than d-AMB, it was associated with acute kidney injury compared with other drugs (P <0.05). CONCLUSION: L-AMB was more effective than other therapies for the treatment of ML. However, a high incidence of toxicity was associated with its use. Therapeutic choices should be reassessed, and the development of new drugs is necessary for the treatment of ML.


Assuntos
Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmania braziliensis , Leishmaniose Mucocutânea/tratamento farmacológico , Lesão Renal Aguda/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anfotericina B/efeitos adversos , Antimônio/efeitos adversos , Antimônio/uso terapêutico , Antiprotozoários/efeitos adversos , Brasil , Estudos de Coortes , Ácido Desoxicólico/efeitos adversos , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Itraconazol/efeitos adversos , Itraconazol/uso terapêutico , Lipossomos , Masculino , Pessoa de Meia-Idade , Pentamidina/efeitos adversos , Pentamidina/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
15.
Cutan Ocul Toxicol ; 38(3): 294-297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31039622

RESUMO

Objective: The aim of this study was to analyze the effect of pentavalent antimonials used in the treatment of cutaneous leishmaniasis (CL) on hemogram and biochemical parameters. Material and methods: The study consisted of 168 patients diagnosed with CL after microscopic examination and treated with either systemic sodium stibogluconate (SSG) or meglumine antimonate (MA) 20 mg/kg/day for 14 days. The patients were divided into two groups as SSG and MA patients. Neutrophil count, leukocyte count, lymphocyte count, hemoglobin concentration, platelet count, amylase, lipase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen and serum creatinine levels were compared before and on the 14th day of the treatment. Results: There was a statistically significant decrease in the neutrophil, lymphocyte, leukocyte, platelet counts, and hemoglobin and blood urea nitrogen levels on the 14th day of the treatment when compared to the pre-treatment values. A statistically significant increase was found in the ALT, AST, amylase and lipase levels. No significant change was found in the serum creatinine levels. Conclusion: According to the results of our study, pentavalent antimonials given standard doses in the treatment of CL can lead to an increase in the pancreatic enzymes and transaminases and bone marrow suppression. We do not recommend any change in the treatment if these conditions are not corroborated by clinical findings.


Assuntos
Gluconato de Antimônio e Sódio/efeitos adversos , Antiprotozoários/efeitos adversos , Leishmaniose Cutânea/tratamento farmacológico , Antimoniato de Meglumina/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Amilases/sangue , Aspartato Aminotransferases/sangue , Contagem de Células Sanguíneas , Nitrogênio da Ureia Sanguínea , Criança , Pré-Escolar , Creatinina/sangue , Feminino , Humanos , Lactente , Leishmaniose Cutânea/sangue , Lipase/sangue , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Mymensingh Med J ; 28(2): 328-332, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086147

RESUMO

Post Kala-azar Dermal Leishmaniasis (PKDL) is the sequel of visceral leishmaniasis in Indian subcontinent and may appear among patients with or without previous history of visceral leishmaniasis (VL). The aim of the study is to understand the male reproductive safety profile of miltefosine used for the treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) in Bangladesh. From January 2017 to March 2017, an exploratory study was carried out on male fertility capacity in Bangladesh among male patients above 14 years old with PKDL treated with miltefosine. Twenty nine male patients were included to observe the effect of miltefosine on reproductive health. All PKDL patients had history of visceral leishmaniasis (VL) in different time periods. Among them three (10.3%) patients were unable to ejaculate semen. In semen analysis, 3 patients (10.3%) were found azoospermia (sperm count & motility- 0, viscosity- good, pH- 7 to 8), microscopically there was presence of RBC (5-15/HPF), WBC (8-15/HPF). Another 3 patients (10.3%) were found oligospermia (sperm count- 4.2 to 15.3 million/ml, motility- 20 to 50%, viscosity- good, pH- 6 to 9, RBC- 4 to 15/HPF, WBC- 4 to 15/HPF). The study documented some important findings in evaluating male infertility and selection of drug regimens in treating PKDL patients with miltefosine for 12 weeks.


Assuntos
Antiprotozoários/uso terapêutico , Infertilidade Masculina/induzido quimicamente , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Visceral/tratamento farmacológico , Fosforilcolina/análogos & derivados , Adolescente , Antiprotozoários/efeitos adversos , Bangladesh , Fertilidade , Humanos , Masculino , Fosforilcolina/efeitos adversos , Fosforilcolina/uso terapêutico , Resultado do Tratamento
17.
An. bras. dermatol ; 94(3): 355-357, May-June 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1011111

RESUMO

Abstract: Pentavalent antimonials are the first-line drug treatment for American tegumentary leishmaniasis. We report on a patient with chronic renal failure on hemodialysis who presented with cutaneous lesions of leishmaniasis for four months. The patient was treated with intravenous meglumine under strict nephrological surveillance, but cardiotoxicity, acute pancreatitis, pancytopenia, and cardiogenic shock developed rapidly. Deficient renal clearance of meglumine antimoniate can result in severe toxicity, as observed in this case. These side effects are related to cumulative plasma levels of the drug. Therefore, second-line drugs like amphotericin B are a better choice for patients on dialysis.


Assuntos
Humanos , Masculino , Adulto , Leishmaniose Cutânea/complicações , Leishmaniose Cutânea/tratamento farmacológico , Insuficiência Renal Crônica/complicações , /efeitos adversos , Antiprotozoários/efeitos adversos , Brasil , Anfotericina B/uso terapêutico , Diálise Renal , Leishmaniose Cutânea/patologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Antiprotozoários/uso terapêutico
19.
Acta Trop ; 193: 176-182, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30851256

RESUMO

Cutaneous leishmaniasis (CL) is not a life-threatening condition. However, its treatment can cause serious adverse effects and may sometimes lead to death. Recently, safer local treatments have been included among therapies acceptable to New World CL cases, but the use of intralesional meglumine antimoniate (IL-MA) is recommended to be performed in reference centers, for patients with single cutaneous lesions <3 cm in diameter at any location except the head and periarticular regions; the volume of injected MA should not exceed 5 mL. In this study we compared two groups of patients with CL treated with MA in a primary health care unit in Brazil. Patients were treated with systemic MA (n = 76) or IL-MA (n = 30). In the IL-MA group, 93% of patients had one or more of the following lesion characteristics: two or more lesions, lesions >3 cm in diameter, lesions located in the head or in periarticular regions, or had been administered IL-MA volumes >5 mL. Patients responded well (68.4% and 66.7% for the MA and IL-MA groups, respectively). When a second cycle of treatment was necessary, the responses were 72.4% and 90%, respectively. There were no significant differences between groups. In the IL-MA group, 43% had mild to moderate adverse effects, without needing treatment discontinuation. Results suggest that the treatment of CL lesions with IL-MA is simple, efficient, and safe.


Assuntos
Antiprotozoários/administração & dosagem , Leishmaniose Cutânea/tratamento farmacológico , Antimoniato de Meglumina/administração & dosagem , Atenção Primária à Saúde , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Antiprotozoários/efeitos adversos , Brasil , Feminino , Humanos , Injeções Intralesionais , Injeções Intramusculares , Injeções Intravenosas , Masculino , Antimoniato de Meglumina/efeitos adversos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
20.
Exp Parasitol ; 199: 47-51, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30825499

RESUMO

The aim of this study was to evaluate in vitro the efficacy of cordycepin and pentostatin (alone or combined) against Trypanosoma cruzi, as well as the therapeutic efficiency of protocols of cordycepin and pentostatin combinations in mice experimentally infected with T. cruzi. In vitro, the cordycepin (3'-deoxyadenosine) and pentostatin (deoxycoformycin) exerted potent trypanocidal effect against T. cruzi (Colombian strain), similarly to benznidazole, which is the reference drug. For epimastigotes, the lethal dose of cordycepin capable of killing 50% (LD50) and 20% (LD20) of the parasites was 0.072 and 0.031 mg/mL, respectively and for trypomastigotes was 0.047 and 0.015 mg/mL, respectively. The combined use of cordycepin and pentostatin resulted in a LD50 and LD20 for epimastigotes of 0.068 and 0.027 mg/mL, respectively, as well as 0.056 and 0.018 mg/mL for trypomastigotes, respectively. In vivo, the combined use of cordycepin and pentostatin did not show the expected curative effect, however it was able to control the parasitema in the peak period. In summary, the combination of cordycepin and pentostatin showed no curative effect in mice infected by T. cruzi, despite the in vitro reduction of epimastigotes and trypomastigotes.


Assuntos
Antiprotozoários/farmacologia , Doença de Chagas/tratamento farmacológico , Desoxiadenosinas/farmacologia , Pentostatina/farmacologia , Trypanosoma cruzi/efeitos dos fármacos , Análise de Variância , Animais , Antiprotozoários/efeitos adversos , Antiprotozoários/uso terapêutico , Doença de Chagas/parasitologia , Desoxiadenosinas/uso terapêutico , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Coração/efeitos dos fármacos , Dose Letal Mediana , Camundongos , Miocárdio/patologia , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/parasitologia , Nifurtimox/efeitos adversos , Nifurtimox/uso terapêutico , Nitroimidazóis/efeitos adversos , Nitroimidazóis/uso terapêutico , Dinâmica não Linear , Parasitemia/prevenção & controle , Pentostatina/uso terapêutico , Distribuição Aleatória , Análise de Regressão
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