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1.
Rev Soc Bras Med Trop ; 54: e04542020, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33533816

RESUMO

INTRODUCTION: The objective of this study was to estimate the direct medical costs of the treatment for mucosal leishmaniasis (ML) using three therapeutic approaches in the Brazilian context. METHODS: We performed this economic assessment from the perspective of the Brazilian public healthcare system. The following therapeutic approaches were evaluated: meglumine antimoniate, liposomal amphotericin B, and miltefosine. Direct medical costs were estimated considering four treatment components: a) drug, b) combined medical products, c) procedures, and d) complementary tests. RESULTS: Treatment with meglumine antimoniate had the lowest average cost per patient (US$ 167.66), followed by miltefosine (US$ 259.92) in the outpatient treatment regimen. The average cost of treatment with liposomal amphotericin B was US$ 715.35 both in inpatient regimen. In all estimates, the drugs accounted for more than 60% of the total cost for each treatment approach. CONCLUSIONS: These results demonstrate the marked differences in costs between the therapeutic alternatives for ML. In addition to efficacy rates and costs related to adverse events, our data have the potential to support a complete cost-effectiveness study in the future. Complete analyses comparing costs and benefits for interventions will assist health managers in choosing drugs for ML treatment in Brazil as well as in establishing effective public health policies.


Assuntos
Antiprotozoários , Leishmaniose Mucocutânea , Antiprotozoários/uso terapêutico , Brasil , Análise Custo-Benefício , Humanos , Leishmaniose Mucocutânea/tratamento farmacológico , Antimoniato de Meglumina/uso terapêutico
2.
Am J Trop Med Hyg ; 103(4): 1493-1495, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32748768

RESUMO

Mucosal leishmaniasis (ML) affects predominantly the nose and occurs usually weeks or months after the cure of the primary cutaneous lesion. The pathology of ML is characterized by an exaggerated inflammatory reaction with infiltration of lymphocytes, macrophages, and plasma cells. There is also a paucity of parasites and a strong delayed-type hypersensitivity reaction. Herein, we report a case of a young man who had a large ulcer in his left leg and complained of dysphagia. In nasofibrolaryngoscopy, there were nodular lesions in the oropharynx and rhinopharynx. The skin lesion biopsy showed a chronic inflammation with amastigotes inside macrophages, and DNA of Leishmania braziliensis confirmed the diagnosis of ML in tissue biopsied from the pharynx. The leishmaniasis skin test was negative. Cytokine evaluation showed lack of production of interferon (IFN)-γ, interleukin (IL)-1ß, and IL-17 with enhancement of these cytokine levels after cure.


Assuntos
Leishmania braziliensis/isolamento & purificação , Leishmaniose Mucocutânea , Antiprotozoários/uso terapêutico , Citocinas/efeitos dos fármacos , Citocinas/metabolismo , Transtornos de Deglutição/tratamento farmacológico , Transtornos de Deglutição/etiologia , Humanos , Leishmania braziliensis/efeitos dos fármacos , Leishmaniose Mucocutânea/diagnóstico , Leishmaniose Mucocutânea/tratamento farmacológico , Leishmaniose Mucocutânea/patologia , Macrófagos/parasitologia , Masculino , Antimoniato de Meglumina/uso terapêutico , Pessoa de Meia-Idade , Nasofaringe/parasitologia , Nasofaringe/patologia , Orofaringe/parasitologia , Orofaringe/patologia , Pele/parasitologia , Pele/patologia
3.
Am J Trop Med Hyg ; 103(2): 752-755, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32524951

RESUMO

An 88-year-old man with mutilating mucosal leishmaniasis (ML) involving septal perforation, with granulomas in the pharynx and larynx, was treated with oral miltefosine, 50 mg three times/day for 28 days. Miltefosine, an antineoplastic agent, is considered an alternative option for the treatment of ML, showing efficacies of 75-92% in Bolivia, Brazil, and Argentina. The patient denied having previous cutaneous (CL) leishmaniasis, and no CL lesions were recognized by physical examination. Parasites obtained from mucosal lesions were identified by cytochrome b gene sequencing as Leishmania guyanensis. Clinical cure was observed 2 months posttreatment, and no evidence of reactivation was observed in the 3-year follow-up. Adverse effects such as nausea, loss of appetite, and epigastric pain were experienced during treatment with miltefosine. There is a need for improved access to miltefosine in leishmaniasis-endemic areas of Latin America and a greater awareness of ML and its treatment among physicians working in endemic countries.


Assuntos
Antiprotozoários/uso terapêutico , Leishmaniose Mucocutânea/tratamento farmacológico , Doenças Nasais/tratamento farmacológico , Doenças Faríngeas/tratamento farmacológico , Fosforilcolina/análogos & derivados , Idoso de 80 Anos ou mais , Citocromos b/genética , Disfonia/etiologia , Humanos , Leishmania guyanensis/genética , Leishmania guyanensis/isolamento & purificação , Masculino , Perfuração do Septo Nasal/etiologia , Doenças Nasais/complicações , Doenças Nasais/patologia , Doenças Faríngeas/complicações , Doenças Faríngeas/patologia , Fosforilcolina/uso terapêutico , Índice de Gravidade de Doença
4.
Rev Soc Bras Med Trop ; 53: e20200040, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578710

RESUMO

Mucocutaneous leishmaniasis (MCL) is a chronic infection that can affect the skin and mucous membranes. We report a case of oral, nasopharyngeal, and penile lesions in a 35-year-old cocaine user. The patient presented with ulcerated lesions in 2014. Histopathologic analysis revealed amastigotes, and serological test results were positive for leishmaniasis. Systemic therapy with meglumine antimoniate was administered; however, the patient failed to present for follow-up. In 2018, he returned with nasal collapse, and another histopathologic test confirmed MCL. This case illustrates the importance of careful differential diagnosis of skin and mucous ulcers to identify the particular pathology.


Assuntos
Antiprotozoários/administração & dosagem , Transtornos Relacionados ao Uso de Cocaína/complicações , Leishmaniose Mucocutânea/diagnóstico , Antimoniato de Meglumina/administração & dosagem , Adulto , Humanos , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/tratamento farmacológico , Masculino
5.
Int J Infect Dis ; 97: 204-207, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32505874

RESUMO

INTRODUCTION: Mucocutaneous leishmaniasis (MCL) is a complication of tegumentary leishmaniasis, causing potentially life-threatening lesions in the ear, nose, and throat (ENT) region, and most commonly due to Leishmania (Viannia) braziliensis. We report a case of relapsing MCL in an Italian traveler returning from Argentina. CASE DESCRIPTION: A 65-year-old Italian male patient with chronic kidney disease, arterial hypertension, prostatic hypertrophy, and type-2 diabetes mellitus was referred for severe relapsing MCL acquired in Argentina. ENT examination showed severe diffuse pharyngolaryngeal edema and erythema, partially obstructing the airways. A nasopharyngeal biopsy revealed a lymphoplasmacytic inflammation and presence of Leishmania amastigotes, subsequently identified as L. (V.) braziliensis by hsp70 PCR-RFLP analysis and sequencing. Despite receiving four courses of liposomal amphotericine B (L-AmB) and two courses of miltefosine over a 2-year period, the patient presented recurrence of symptoms a few months after the end of each course. After the patient was referred to us, a combined treatment was started with intravenous pentamidine 4 mg/kg on alternate days for 10 doses, followed by one dose per week for an additional seven doses, intralesional meglumine antimoniate on the nasal lesion once per week for six doses, oral azoles for three months, and aerosolized L-AmB on alternate days for three months. The treatment led to regression of mucosal lesions and respiratory symptoms. Renal function temporarily worsened, and the addition of insulin was required to maintain glycemic compensation after pentamidine discontinuation. CONCLUSIONS: This case highlights the difficulties in managing a life-threatening refractory case of MCL in an Italian traveler with multiple comorbidities. Even though parenteral antimonial derivatives are traditionally considered the treatment of choice for MCL, they are relatively contraindicated in cases of chronic kidney disease.The required dose adjustment in cases of impaired renal function is unknown, therefore the use of alternative drugs is recommended. This case was resolved with combination treatment, including aerosolized L-AmB, which had never been used before for MCL.


Assuntos
Anfotericina B/administração & dosagem , Antiprotozoários/administração & dosagem , Azóis/administração & dosagem , Leishmaniose Mucocutânea/tratamento farmacológico , Antimoniato de Meglumina/administração & dosagem , Pentamidina/administração & dosagem , Administração Intravenosa , Idoso , Argentina , Quimioterapia Combinada , Humanos , Leishmania braziliensis/efeitos dos fármacos , Leishmania braziliensis/fisiologia , Leishmaniose Mucocutânea/parasitologia , Masculino , Recidiva
6.
Am J Trop Med Hyg ; 102(6): 1319-1322, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32228792

RESUMO

The six previously reported civilian cases of mucosal leishmaniasis (ML) diagnosed in the United States have all represented imported New World ML. We describe two new patients with ML diagnosed in New York City-a Syrian immigrant with a nasal mass (Leishmania tropica), the first report of Old World ML in the United States, and an American ecologist who worked in Bolivia and had been treated for cutaneous infection 23 years before developing lesions (L. (Viannia) braziliensis) initially of the uvula, soft palate, and posterior pharynx and subsequently the larynx.


Assuntos
Leishmaniose Mucocutânea/epidemiologia , Leishmaniose Mucocutânea/patologia , Idoso , Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Humanos , Leishmania braziliensis/isolamento & purificação , Leishmaniose Mucocutânea/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Fosforilcolina/análogos & derivados , Fosforilcolina/uso terapêutico
7.
Parasit Vectors ; 13(1): 24, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931865

RESUMO

BACKGROUND: Leishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin. The aim of this study was to evaluate epidemiological and clinical characteristics of cutaneous (CL) and mucocutaneous leishmaniasis (MCL) in La Fe University Hospital, Valencia, Spain. The particular focus was on diagnosis techniques and clinical differences according to the immunological status of the patients. METHODS: An eleven-year retrospective observational study of CL and MCL episodes at the hospital was performed. Epidemiological, clinical and therapeutic variables of each case, together with the microbiological and anatomopathological diagnosis, were analyzed. RESULTS: A total of 42 patients were included, 30 of them were male and 28 were immunocompetent. Most of the cases (36/42) were diagnosed in the last 5 years (2013-2017). The incidence of CL and MCL increased from 3.6/100,000 (2006-2012) to 13.58/100,000 (2013-2017). The majority of the patients (37/42) exhibited CL, in 30 cases as single lesions (30/37). Ulcerative lesions were more common in immunosuppressed patients (13/14) than in immunocompetent patients (20/28), (P = 0.2302). The length of lesion presence before diagnosis was 7.36 ± 6.72 months in immunocompetent patients and 8.79 ± 6.9 months in immunosuppressed patients (P = 0.1863). Leishmania DNA detection (92.3%) was the most sensitive diagnostic technique followed by Giemsa stain (65%) and histopathological examination (53.8%). Twelve patients (12/42) had close contact with dogs or were living near to kennels, and 10 of them did not present underlying conditions. Intralesional glucantime (21/42) and liposomal amphotericin B (7/42) were the most common treatments administered in monotherapy. All patients evolved successfully and no relapse was reported. CONCLUSIONS: Some interesting clinical and epidemiological differences were found in our series between immunocompetent and immunosuppressed patients. Future studies can take these results further especially by studying patients with biological therapy. Skin biopsies combining NAAT with histological techniques are the most productive techniques for CL or MCL diagnosis.


Assuntos
Leishmania/efeitos dos fármacos , Leishmaniose Cutânea , Leishmaniose Mucocutânea , Administração Cutânea , Adolescente , Adulto , Idoso , Anfotericina B/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Hospedeiro Imunocomprometido , Leishmania/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/imunologia , Leishmaniose Cutânea/patologia , Leishmaniose Mucocutânea/diagnóstico , Leishmaniose Mucocutânea/tratamento farmacológico , Leishmaniose Mucocutânea/imunologia , Leishmaniose Mucocutânea/patologia , Masculino , Antimoniato de Meglumina/administração & dosagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Adulto Jovem
8.
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
9.
Infez Med ; 27(4): 452-455, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31846999

RESUMO

The management of mucosal leishmaniasis in immunocompromised patients is not standardized and limited data are available on the use of miltefosine for treatment and secondary prophylaxis. We describe a case of mucosal leishmaniasis in an HIV-coinfected patient treated with miltefosine due to a severe allergic reaction to liposomal amphotericin B.


Assuntos
Leishmaniose Mucocutânea/tratamento farmacológico , Fosforilcolina/análogos & derivados , Coinfecção , Infecções por HIV/complicações , Humanos , Leishmaniose Mucocutânea/complicações , Masculino , Pessoa de Meia-Idade , Fosforilcolina/uso terapêutico , Fatores de Tempo
10.
Rev. esp. cir. oral maxilofac ; 41(4): 194-196, oct.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-191806

RESUMO

La leishmaniasis es una infección endémica en nuestro medio. Dentro de sus presentaciones, la forma mucocutánea es la menos frecuente. A pesar de ello se ha de tener en cuenta incluso en casos clínicamente sugestivos de patología tumoral, como el que presentamos


Leishmaniasis is an endemic disease in the mediterranean region. Although mucocutaneous presentation is not frequent, we should considerate it in the differential diagnosis of tumoral pathology


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Leishmaniose Cutânea/diagnóstico , Leishmania/isolamento & purificação , Dermatopatias Infecciosas/diagnóstico , Leishmaniose Mucocutânea/tratamento farmacológico , Diagnóstico Diferencial , Doenças Labiais/microbiologia , Leishmaniose Mucocutânea/etiologia , Mordeduras e Picadas de Insetos/complicações , Antimoniato de Meglumina/uso terapêutico
11.
Int J Parasitol Drugs Drug Resist ; 11: 177-179, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31492621

RESUMO

Mucosal leishmaniasis (ML) is mostly associated with Leishmania braziliensis; however, a few cases of Leishmania tropica induced mucocutaneous leishmaniasis have been reported. The standard treatment for leishmaniasis is pentavalent antimonials, but several other drugs for resistant cases have been proposed including amphotericin and miltefosine. Here we present a case of multiple treatment resistant mucocutaneous leishmaniasis with nasal involvement caused by L. tropica; cure was not achieved by multiple treatments and was eventually improved by adding thalidomide to Meglumine Antimoniate (Glucantime). To the best of our knowledge use of thalidomide in humans for leishmaniasis treatment is reported here for the first time.


Assuntos
Antiprotozoários/uso terapêutico , Leishmaniose Mucocutânea/tratamento farmacológico , Antimoniato de Meglumina/uso terapêutico , Talidomida/uso terapêutico , Humanos , Irã (Geográfico) , Leishmania tropica , Masculino , Nariz/parasitologia , Adulto Jovem
12.
Am J Trop Med Hyg ; 101(5): 1107-1110, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31549620

RESUMO

Mucocutaneous leishmaniasis (MCL) is a rare infection caused by several species within the genus Leishmania. We present a patient with multifocal MCL masquerading as idiopathic midline granulomatous disease, featuring the unusual complication of ocular leishmaniasis, as a result of prolonged immunosuppressive therapy. We review clinical features, diagnosis, and treatment of this syndrome.


Assuntos
Doença Granulomatosa Crônica/diagnóstico , Leishmaniose Mucocutânea/diagnóstico , Leishmaniose Mucocutânea/patologia , Adulto , Anfotericina B/uso terapêutico , Feminino , Doença Granulomatosa Crônica/tratamento farmacológico , Humanos , Imunossupressores , Leishmania/classificação , Leishmania/isolamento & purificação , Leishmaniose Mucocutânea/tratamento farmacológico
13.
Am J Trop Med Hyg ; 101(2): 392-401, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31219000

RESUMO

Mucosal leishmaniasis (ML) is characterized by high production of inflammatory cytokines. Administration of pentoxifylline (PTX), an inhibitor of TNF-alpha, with pentavalent antimony (Sbv), has been successfully used as alternative treatment for refractory ML. Our study aims to investigate the in situ cellular response underlying the effectiveness of this therapy, by evaluating the intensity of the inflammatory infiltrate, cellular composition, and expression of cytokines and granzyme A in lesions from ML before and after treatment with Sbv alone or in combination with PTX. Our data showed no differences in the intensity of inflammatory infiltrate comparing before and after treatment, and comparing between different treatments. However, although the number and frequency of CD4+ and CD8+ cells were not different before and after treatments or comparing different treatments, frequency of CD68+ cells decreased after treatment with Sbv + PTX, but not with Sbv. This was due to a reduction in CD68+ TNF-alpha+ and not in CD68+ IL-10+ cells. The frequency of TNF-alpha+ cells was correlated with the intensity of the inflammatory infiltrate before treatment, but this correlation was lost after treatment with Sbv + PTX. Although the total expression of granzyme A did not significantly change after treatments, a clear trend of decrease was observed after treatment with Sbv + PTX. Interestingly, patients who took longer to heal, regardless of the treatment, displayed a higher frequency of granzyme A+ cells. Our data suggest that treatment with Sbv + PTX acts in CD68+ cells reducing the expression of TNF-alpha but not IL-10, resulting in more efficient modulation of the inflammatory response, accelerating the healing process.


Assuntos
Antimônio/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmaniose Mucocutânea/tratamento farmacológico , Leishmaniose Mucocutânea/imunologia , Pentoxifilina/uso terapêutico , Adulto , Idoso , Citocinas/imunologia , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Granzimas/imunologia , Humanos , Inflamação/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Linfócitos T/imunologia , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto Jovem
14.
Am J Trop Med Hyg ; 101(2): 402-403, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31219006

RESUMO

Immunosuppressive treatments for rheumatic diseases present special problems in areas endemic for chronic infectious diseases because of the possibility of reactivation. Leishmaniasis is a significant neglected tropical disease caused by different species of protozoan parasites within the genus Leishmania. Amastigotes live as intracellular parasites in a variety of mammalian cells, most notably within phagocytes such as macrophages, and residual parasites can persist even after treatment and healing of the lesions. We herein report a case of relapsing mucosal leishmaniasis after aggressive immunotherapy for ankylosing spondylitis, with requirement for secondary prophylaxis with amphotericin B to prevent reactivation. This approach can be necessary for patients from endemic areas of tegumentary leishmaniasis, who will undergo aggressive immunotherapy.


Assuntos
Anfotericina B/administração & dosagem , Antiprotozoários/administração & dosagem , Leishmaniose Mucocutânea/tratamento farmacológico , Prevenção Secundária/métodos , Espondilite Anquilosante/imunologia , Espondilite Anquilosante/terapia , Adulto , Humanos , Imunossupressores/efeitos adversos , Imunoterapia , Masculino , Recidiva , Espondilite Anquilosante/complicações
15.
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
16.
Rev Soc Bras Med Trop ; 52: e20180292, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30942258

RESUMO

INTRODUCTION: The treatment of mucosal leishmaniasis (ML) is difficult due to the toxicity and route of administration of standard drugs. Miltefosine is an oral agent used for leishmaniasis treatment; however, no data exist regarding its use for ML in Brazil. In this study, we aimed to evaluate the efficacy of miltefosine for ML treatment compared to that of pentavalent antimonial in a pilot study. METHODS: We performed a randomized clinical trial with two parallel groups. The tested intervention consisted of miltefosine 1.3-2 mg/kg/day (two capsules) for 28 days or intravenous 20 mg SbV/kg/day of meglumine antimoniate (N-MA) for 30 days. The final endpoint was defined as complete healing of the lesion four years after treatment. We also analyzed an early endpoint at 90 days after treatment. RESULTS: Forty patients were included in this study: each experimental group comprised 20 patients. Applying a multivariate model in an intention-to-treat analysis, we observed that patients treated with miltefosine had a cure probability 2.08 times greater (95% confidence interval [CI] = 1.03-4.18) than those treated with N-MA at 90 days after treatment. At the final endpoint, we observed no differences in cure probability between miltefosine and N-MA (relative risk = 0.66; 95% CI = 0.33-1.32). With respect to adverse reactions, significant differences between groups were related to gastrointestinal effects, which were more frequent in the miltefosine group. CONCLUSIONS: Miltefosine may be an interesting alternative for treating ML because of its oral administration and cure rate after long-term follow-up.


Assuntos
Antiprotozoários/administração & dosagem , Leishmaniose Mucocutânea/tratamento farmacológico , Antimoniato de Meglumina/administração & dosagem , Fosforilcolina/análogos & derivados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fosforilcolina/administração & dosagem , Projetos Piloto , Fatores de Tempo , Resultado do Tratamento
19.
Rev Soc Bras Med Trop ; 52: e20180236, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30652793

RESUMO

In Brazil, meglumine antimoniate is the first drug of choice for mucosal leishmaniasis treatment followed by amphotericin B and pentamidine isethionate. We report the case of a patient with severe mucosal lesions caused by Leishmania (Viannia) braziliensis that were difficult to treat. Over a 14-year period, the patient showed low adherence and three treatment attempts with meglumine antimoniate failed. Additionally, there was an unsatisfactory response to liposomal amphotericin B and nephrotoxicity when using amphotericin B deoxycholate that persisted after new treatment attempt with liposomal amphotericin B. Finally, healing was achieved with pentamidine isethionate and maintained during nine months of monitoring.


Assuntos
Antiprotozoários/uso terapêutico , Leishmania braziliensis/efeitos dos fármacos , Leishmaniose Mucocutânea/tratamento farmacológico , Pentamidina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
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