RESUMO
Although intralesional meglumine antimoniate (MA) infiltration is considered an option for cutaneous leishmaniasis (CL) therapy and is widely used in the Old World, there have been few studies supporting this therapeutic approach in the Americas. This study aims to describe outcomes and adverse events associated with intralesional therapy for CL. This retrospective study reviewed the experience of a Brazilian leishmaniasis reference centre using intralesional MA to treat 31 patients over five years (2008 and 2013). The median age was 63 years (22-86) and the median duration time of the lesions up to treatment was 16 weeks. In 22 patients (71%), intralesional therapy was indicated due to the presence of contraindications or previous serious adverse events with systemic MA. Other indications were failure of systemic therapy or ease of administration. Intralesional treatment consisted of one-six infiltrations (median three) for a period of up to 12 weeks. The initial (three months) and definitive (six months) cure rates were 70.9% and 67.7%, respectively. Most patients reported mild discomfort during infiltration and no serious adverse events were observed. In conclusion, these results show that the intralesional MA efficacy rate was very similar to that of systemic MA treatment, and reinforce the need for further studies with adequate design to establish the efficacy and safety of this therapeutic approach.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Antiprotozoários/administração & dosagem , Leishmaniose Cutânea/tratamento farmacológico , Meglumina/administração & dosagem , Compostos Organometálicos/administração & dosagem , Antiprotozoários/efeitos adversos , Injeções Intralesionais , Leishmaniose Cutânea/patologia , Meglumina/efeitos adversos , Compostos Organometálicos/efeitos adversos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Introduction: Visceral leishmaniasis is an endemic protozoan found in Brazil. It is characterized by fever, pallor, hepatosplenomegaly, lymphadenopathy, and progressive weakness in the patient. It may lead to death if untreated. The drug of choice for treatment is meglumine antimoniate (Glucantime®). The aim of this study was to evaluate patients with visceral leishmaniasis according to criteria used for diagnosis, possible reactions to Glucantime® and blood pressure measured before and after treatment. Methods: 89 patients admitted to the Teaching Hospital Dr. Hélvio Auto (HEHA) in Maceió-AL, in the period from May 2006 to December 2009 were evaluated. Data were collected on age, sex, origin, method of diagnosis, adverse effects of drugs, duration of hospitalization, duration of treatment and dosage up to the onset of adverse effects. Results: There was a predominance of child male patients, aged between one and five years old, from the interior of the State of Alagoas. Parasitological diagnosis was made by bone marrow aspirate; three (3.37%) patients died, 12 (13.48%) had adverse reactions and treatment was changed to amphotericin B, and 74 (83.14%) were cured. Changes that led to replacing Glucantime® were persistent fever, jaundice, rash, bleeding and cyanosis. Conclusion: During the study, 89 patients hospitalized for VL were analyzed: 74 were healed, 12 were replaced by amphotericin B treatment and three died. Most of them were under five years old, male and came from the interior. The dosage and duration of treatment with Glucantime® were consistent with that advocated by the Ministry of Health. Persistence of fever, jaundice, rash, cyanosis and bleeding were the reactions that led the physician to modify treatment. No change was observed in blood pressure before and after treatment. This study demonstrated the work of a hospital, a reference in the treatment of leishmaniasis, which has many patients demanding its services in this area. It demonstrates that this disease is still important today, and needs to be addressed properly to prevent injury and death due to the disease.
A Leishmaniose visceral é doença infecciosa causada por protozoários das espécies chagasi e donovani sendo transmitida pela picada de insetos fêmea dos gêneros Lutzomyia e Phlebotomos. Constitui doença febril, determinando amplo aspecto de manifestações clínicas e prognóstico variável, que pode levar à morte se não for tratada. É doença endêmica encontrada no Brasil e nos últimos anos verificou-se intenso processo de urbanização da endemia e aumento da letalidade por leishmaniose visceral. O estudo teve como objetivo avaliar pacientes com leishmaniose visceral de acordo com os critérios utilizados para o diagnóstico, possíveis reações ao Glucantime® e pressão arterial, medidos antes e após o tratamento. Métodos: Foram avaliados 89 pacientes internados no Hospital Universitário Dr. Hélvio Auto (HEHA), em Maceió-AL, no período de maio de 2006 a dezembro de 2009. Foram coletados dados sobre idade, sexo, origem, método de diagnóstico, efeitos adversos da droga, duração da hospitalização, duração do tratamento e dose até o aparecimento de efeitos adversos. Resultados: Houve predomínio de crianças do sexo masculino, com idade entre um e cinco anos, a partir do interior do Estado de Alagoas. O diagnóstico parasitológico foi feito pelo aspirado de medula óssea, três (3,37%) pacientes morreram, 12 (13,48 %) apresentaram reações adversas e o tratamento foi alterado para anfotericina B, e 74 (83,14 %) foram curados. As alterações que levaram à substituição de Glucantime® foi febre persistente. A dosagem e duração do tratamento com Glucantime® foi seguido como preconizado pelo Ministério da Saúde. A persistência de febre, icterícia, prurido, cianose e sangramento foram as reações que levaram o médico a modificar o tratamento. Nenhuma mudança foi observada na pressão arterial antes e após o tratamento. O estudo realizado demonstrou o perfil de um Hospital, que recebe grande demanda de casos de leishmaniose visceral. Isso demonstra que essa doença continua sendo importante na atualidade, precisando ser abordada de maneira adequada, evitando assim agravos e mortes pela doença.