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Rev. Ciênc. Méd. Biol. (Impr.) ; 20(1): 131-136, maio 5, 2021. fi, ilus
Article in Portuguese | LILACS | ID: biblio-1355067


Introdução: a Leishmaniose Tegumentar Americana (LTA) é uma infecção zoonótica cujo tratamento é realizado com a droga antimoniato de meglumina (AM). Objetivo: Relatar as alterações eletrocardiográficas decorrentes do uso de AM em pacientes com LTA. Metodologia: foi realizada uma revisão integrativa da literatura por meio das bases de dados BIREME, PUBMED, COCHRANE, SCIELO e literatura cinzenta, usando como estratégia de busca o cruzamento dos seguintes descritores, nos idiomas português e inglês: leishmaniose cutânea, eletrocardiografia, meglumina e toxicidade. Não foi estipulado um intervalo temporal para que um maior número de publicações fosse obtido. Resultados: foram encontrados 134 artigos, desses apenas 09 atenderam aos critérios de inclusão. As principais alterações eletrocardiográficas encontradas durante a terapêutica foram as alterações de repolarização ventricular, com destaque para o prolongamento do intervalo QT corrigido pela frequência cardíaca. Já entre as alterações mais graves em termos de morbimortalidade, destacam-se as arritmias ventriculares complexas, principalmente a Torsade de pointes. Discussão: em todos os artigos selecionados foram encontradas alterações ao eletrocardiograma (ECG) durante o tratamento com AM, sendo recomendado em todos os pacientes, o acompanhamento eletrocardiográfico. Apenas um estudo excluiu as alterações do ECG basal, presença de comorbidades e uso de drogas cardiotóxicas sendo esses possíveis vieses para avaliação da toxicidade cardíaca diretamente provocada pelo antimonial. Conclusão: considerando as alterações na repolarização ventricular e as possíveis arritmias ventriculares em pacientes em tratamento para LTA em uso de AM, o acompanhamento eletrocardiográfico é recomendado durante a terapêutica de todos esses pacientes, sendo útil para prevenção de complicações cardiovasculares importantes.

Introduction: American Tegumentary Leishmaniasis (ATL) is a zoonotic infection whose treatment is carried out with the meglumine antimoniate drug (AM). Objective: To report the electrocardiographic changes resulting from the use of AM in patients with ATL. Methodology: an integrative literature review was carried out using the BIREME, PUBMED, COCHRANE, SCIELO and gray literature databases, using as a search strategy the crossing of the following descriptors, in Portuguese and English: cutaneous leishmaniasis, electrocardiography, meglumine and toxicity. A time interval was not stipulated in order to obtain a greater number of publications. Results: we found 134 articles, of which only 9 met the inclusion criteria. The main electrocardiographic changes found during therapy were changes in ventricular repolarization, with emphasis on the prolongation of the QT interval corrected by heart rate. Already the most serious changes in terms of morbidity and mortality, complex ventricular arrhythmias, especially Torsade de pointes, stand out. Discussion: changes in the electrocardiogram (ECG) were found in all selected articles during treatment with AM, with electrocardiographic monitoring being recommended in all patients. Only one study excluded: changes in the baseline ECG, the presence of comorbidities and / or use of cardiotoxic drugs, these being possible biases to assess cardiac toxicity directly caused by the antimonial. Conclusion: considering the changes in ventricular repolarization and possible ventricular arrhythmias in patients undergoing treatment for ATL using AM, electrocardiographic monitoring is recommended during the therapy of all these patients, being useful for the prevention of important cardiovascular complications.

Humans , Male , Female , Electrocardiography, Ambulatory , Leishmaniasis, Cutaneous , Toxicity , Meglumine Antimoniate , Review
Rev. Soc. Bras. Med. Trop ; 54: e04542020, 2021. tab
Article in English | LILACS | ID: biblio-1155531


Abstract 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.

Humans , Leishmaniasis, Mucocutaneous/drug therapy , Antiprotozoal Agents/therapeutic use , Brazil , Cost-Benefit Analysis , Meglumine Antimoniate/therapeutic use
J. venom. anim. toxins incl. trop. dis ; 25: e144618, 2019. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-990126


Cutaneous leishmaniasis (CL) is a parasitic disease caused by the protozoan Leishmania spp. Pentavalent antimonial agents have been used as an effective therapy, despite their side effects and resistant cases. Their pharmacokinetics remain largely unexplored. This study aimed to investigate the pharmacokinetic profile of meglumine antimoniate in a murine model of cutaneous leishmaniasis using a radiotracer approach. Methods: Meglumine antimoniate was neutron-irradiated inside a nuclear reactor and was administered once intraperitoneally to uninfected and L. amazonensis-infected BALB/c mice. Different organs and tissues were collected and the total antimony was measured. Results: Higher antimony levels were found in infected than uninfected footpad (0.29% IA vs. 0.14% IA, p = 0.0057) and maintained the concentration. The animals accumulated and retained antimony in the liver, which cleared slowly. The kidney and intestinal uptake data support the hypothesis that antimony has two elimination pathways, first through renal excretion, followed by biliary excretion. Both processes demonstrated a biphasic elimination profile classified as fast and slow. In the blood, antimony followed a biexponential open model. Infected mice showed a lower maximum concentration (6.2% IA/mL vs. 11.8% IA/mL, p = 0.0001), a 2.5-fold smaller area under the curve, a 2.7-fold reduction in the mean residence time, and a 2.5-fold higher clearance rate when compared to the uninfected mice. Conclusions: neutron-irradiated meglumine antimoniate concentrates in infected footpad, while the infection affects antimony pharmacokinetics.(AU)

Animals , Mice , Pharmacokinetics , Leishmaniasis, Cutaneous , Meglumine Antimoniate , Infections , Leishmania , Antimony , Neutrons
Rev. Soc. Bras. Med. Trop ; 52: e20180211, 2019. tab, graf
Article in English | LILACS | ID: biblio-1003136


Abstract Cutaneous leishmaniasis (CL) is a high-morbidity, vector-borne disease endemic to Colombia. Unlike conventional systemic antileishmanial therapy, intralesional meglumine antimoniate administration has fewer adverse effects and can be as effective and safe. We describe 12 patients treated with intralesional meglumine antimoniate: seven with primary and five with recurrent lesions. The majority (11/12) met all cure criteria after 1-7 sessions of meglumine antimoniate administration (1-5 mL). Adverse effects comprised mainly of local pain and edema. Intralesional meglumine antimoniate administration could be an excellent alternative treatment for uncomplicated CL; however, controlled clinical trials are needed to test the efficacy and safety thereof.

Humans , Male , Female , Infant , Adult , Young Adult , Leishmaniasis, Cutaneous/drug therapy , Meglumine Antimoniate/administration & dosage , Antiprotozoal Agents/administration & dosage , Injections, Intralesional , Treatment Outcome
Rev. Soc. Bras. Med. Trop ; 51(6): 769-780, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-977099


Abstract INTRODUCTION: Favorable responses in American tegumentary leishmaniasis (ATL) patients to treatment with 5 mg Sbv/kg/day meglumine antimoniate (MA) has been reported in Rio de Janeiro, but little is known regarding the therapeutic response to low doses in patients from other locations. METHODS: A retrospective review of medical records was conducted to compare the therapeutic response to 5 mg Sbv/kg/day MA treatment among 36 patients who acquired ATL in Brazilian states other than Rio de Janeiro (OS group) and 72 patients from Rio de Janeiro (RJ group). RESULTS: One course of 5 mg Sbv/kg/day MA cured 72.8% of 81 cutaneous (CL) and 66.6% of 27 mucosal (ML) leishmaniasis-infected patients: 70% in the CL/RJ group, 81% in the CL/OS group, 50% in the ML/RJ group, and 80% in the ML/OS group. After up to two additional treatment courses at the same dose, 88.9% and 85.2% of the CL and ML patients were cured, respectively. Adverse events were observed in 40% of patients in the CL/RJ group, 57% of the CL/OS group, 58% of the ML/RJ group, and 80% of the ML/OS group. No significant differences were observed in the cure rates or adverse effects between the RJ and OS groups. No patients required permanent discontinuation of treatment due to adverse events. CONCLUSIONS: Patients with ATL acquired in both RJ and OS may respond to low-dose MA. While high-dose MA should remain the standard treatment for ATL, low-dose MA might be preferred when toxicity is a primary concern.

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Leishmaniasis, Cutaneous/drug therapy , Meglumine Antimoniate/therapeutic use , Antiprotozoal Agents/therapeutic use , Brazil , Retrospective Studies , Treatment Outcome , Leishmaniasis, Cutaneous/pathology , Geography , Middle Aged
Rev. Soc. Bras. Med. Trop ; 51(3): 318-323, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-957424


Abstract INTRODUCTION Pentavalent antimonials (Sbv) are the most commonly used drugs for the treatment of mucosal leishmaniasis (ML), despite their high toxicity and only moderate efficacy. The aim of this study was to report therapeutic responses with different available options for ML. METHODS This study was based on a review of clinical records of 35 patients (24 men and 11 women) treated between 2009 and 2015. RESULTS The median age of patients was 63 years, and the median duration of the disease was 24 months. Seventeen patients received Sbv, while nine patients were treated with liposomal amphotericin B (AmB), and another nine patients were treated with fluconazole. Patients treated with AmB received a total median accumulated dose of 2550mg. The mean duration of azole use was 120 days, and the daily dose ranged from 450 to 900mg. At the three-month follow-up visit, the cure rate was 35%, 67%, and 22% for Sbv, AmB, and azole groups, respectively. At the six-month follow-up visit, the cure rates for Sbv, AmB, and azole groups were 71%, 78%, and 33%, respectively. CONCLUSIONS There is a scarcity of effective ML treatment alternatives, and based on our observations, fluconazole is not a valid treatment option.

Humans , Male , Female , Adult , Aged , Aged, 80 and over , Leishmaniasis, Mucocutaneous/drug therapy , Fluconazole/therapeutic use , Amphotericin B/therapeutic use , Antimony/therapeutic use , Antiprotozoal Agents/therapeutic use , Severity of Illness Index , Treatment Outcome , Middle Aged
Mem. Inst. Oswaldo Cruz ; 113(2): 71-79, Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-894896


BACKGROUND Despite its recognised toxicity, antimonial therapy continues to be the first-line drug for cutaneous leishmaniasis (CL) treatment. Intralesional administration of meglumine antimoniate (MA) represents an alternative that could reduce the systemic absorption of the drug and its side effects. OBJECTIVES This study aims to validate the standard operational procedure (SOP) for the intralesional infiltration of MA for CL therapy as the first step before the assessment of efficacy and safety related to the procedure. METHODS The SOP was created based on 21 trials retrieved from the literature, direct monitoring of the procedure and consultation with experts. This script was submitted to a formal computer-aided inspection to identify readability, clarity, omission, redundancy and unnecessary information (content validation). For criterion and construct validations, the influence of critical condition changes (compliance with the instructions and professional experience) on outcome conformity (saturation status achievement), tolerability (pain referred) and safety (bleeding) were assessed. FINDINGS The median procedure length was 12 minutes and in 72% of them, patients classified the pain as mild. The bleeding was also classified as mild in 96.6% of the procedures. Full compliance with the SOP was observed in 66% of infiltrations. Despite this, in 100% of the inspected procedures, lesion saturation was observed at the end of infiltration, which means that it tolerates some degree of modification in its execution (robustness) without prejudice to the result. CONCLUSIONS The procedure is reproducible and can be used by professionals without previous training with high success and safety rates.

Humans , Injections, Intralesional/adverse effects , Leishmaniasis, Cutaneous/drug therapy , Meglumine , Antiprotozoal Agents/administration & dosage , Clinical Protocols/standards , Reproducibility of Results
Mem. Inst. Oswaldo Cruz ; 113(9): e180200, 2018. tab, graf
Article in English | LILACS | ID: biblio-955123


BACKGROUND Cutaneous leishmaniasis (CL) is a world-wide health problem which currently lacks effective, affordable and easy to use therapy. Recently, the meglumine antimoniate (MA) intralesional infiltration was included among the acceptable therapies for New World leishmaniasis. While this approach is attractive, there is currently little evidence to support its use in Americas. OBJECTIVES The aim of this study was to provide information about effectiveness and safety of a standardised MA intralesional infiltration technique for the treatment of CL. METHODS It is a single-arm phase II clinical trial conducted at a Brazilian referral centre. CL cases with parasitological confirmation presenting a maximum of three CL-compatible skin lesions were treated with weekly MA intralesional infiltration by using a validated technique, up to a maximum of eight infiltrations. RESULTS A total of 53 patients (62 lesions) were included. Overall, patients received a median of seven infiltrations (IQR25-75% 5-8) over a median treatment period of 43 days (IQR25-75% 28-52 days). The definitive cure rate at D180 was 87% (95% CI:77-96%). The majority of adverse events were local, with mild or moderate intensity. Bacterial secondary infection of the lesion site was observed in 13% of the treated patients, beside two intensity-three adverse events (hypersensitivity reactions).

Humans , Organometallic Compounds/administration & dosage , Leishmaniasis, Cutaneous/drug therapy , /therapeutic use , Injections, Intralesional , Antiprotozoal Agents/adverse effects
Mem. Inst. Oswaldo Cruz ; 112(12): 838-843, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-894858


BACKGROUND American tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL treatment aims at healing the lesions and preventing the development of the late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg Sb5+/kg/day is the first choice of treatment. However, alternative therapies using 5 mg Sb5+/kg/day or intralesional (IL) MA are the usual regimens at the National Institute of Infectious Diseases (NIID), Rio de Janeiro, Brazil. OBJECTIVES To evaluate lethality and the incidence of relapse and development of late ML in CL patients treated at NIID from 2001 until 2013. METHODS Data were recovered from records of all ATL patients diagnosed during that period. FINDINGS Out of 777 patients, 753 were treated with MA (96.9%). Of those, 89.1% received alternative therapy of 9.9% IL and 79.2% systemic 5 mg Sb5+/kg/day. Some patients required 1-3 additional courses of treatment, thus making a total of 997 courses; 85.2% of them were subjected to alternative therapies. Lethality was 0.1%, relapse incidence 5.8%, and late ML incidence 0.25%. As a final outcome for the 777 patients, 95.9% were cured, 0.1% died and 4.0% were not able to follow-up. MAIN CONCLUSIONS Alternative MA schedules resulted in low lethality without increase of relapse or late ML incidence.

Humans , Male , Female , Adult , Middle Aged , Leishmaniasis, Cutaneous/mortality , Leishmaniasis, Cutaneous/drug therapy , Meglumine/administration & dosage , Organometallic Compounds/administration & dosage , Injections, Intralesional/methods , Treatment Outcome
Rev. Soc. Bras. Med. Trop ; 50(2): 269-272, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-842839


Abstract Although New World cutaneous leishmaniasis is not itself a life-threatening disease, its treatment with systemic antimonials can cause toxicity that can be dangerous to some patients. Intralesional meglumine antimoniate provides a viable, less toxic alternative. Herein, we describe an alternative treatment with subcutaneous intralesional injections of meglumine antimoniate into large periarticular lesions of three patients with cutaneous leishmaniasis and comorbidities. This treatment was safe, successful, and well tolerated. This case series suggests that intralesional meglumine antimoniate is an effective therapy for cutaneous leishmaniasis, even with periarticular lesions. This hypothesis should be tested in controlled clinical trials.

Humans , Male , Female , Aged , Organometallic Compounds/administration & dosage , Leishmaniasis, Cutaneous/drug therapy , Meglumine/administration & dosage , Antiprotozoal Agents/administration & dosage , Time Factors , Severity of Illness Index , Injections, Intralesional , Treatment Outcome , Meglumine , Middle Aged
Rev. Soc. Bras. Med. Trop ; 49(6): 774-776, Dec. 2016. graf
Article in English | LILACS | ID: biblio-1041383


Abstract INTRODUCTION: Intralesional treatment for cutaneous leishmaniasis has been applied for over 30 years at the Oswaldo Cruz Foundation, Rio de Janeiro, with good therapeutic results and without relevant systemic toxicity. METHODS Meglumine antimoniate was injected subcutaneously, using a long medium-caliber needle (for example, 30mm × 0.8mm); patients received 1-3 injections, with 15-day intervals. RESULTS The technique is described in detail sufficient to enable replication. CONCLUSIONS: The treatment of cutaneous leishmaniasis with intralesional meglumine antimoniate is a simple, effective, and safe technique, which may be used in basic healthcare settings.

Humans , Organometallic Compounds/administration & dosage , Leishmaniasis, Cutaneous/drug therapy , Meglumine/administration & dosage , Antiprotozoal Agents/administration & dosage , Injections, Intralesional/standards , Meglumine Antimoniate
Acta méd. costarric ; 58(2): 81-83, abr.-jun. 2016. ilus
Article in Spanish | LILACS | ID: lil-779718


El miltefosine (Impávido(r)) es un medicamento de componente antineoplásico que ha encontrado efectividad muy alta contra la leishmaniasis mucocutánea y visceral en el mundo, y se ha convertido en una opción muy atractiva para pacientes con enfermedades de fondo y tratamientos de base que contraindican el uso de amoniato de meglumina (Glucantime(r)) o stibogluconato de sodio (Pentostam(r)). Seguidamente se presenta el caso de un paciente de 78 años con antecedentes de diabetes mellitustipo 2, hipertenso, anticoagulado con warfarina por una fibrilación auricular crónica, que inició una dermatosis ulcerosa de bordes violáceos elevados, única en el hélix del oído derecho, de evolución crónica asociada a múltiples ulceraciones en la mucosa nasal. La biopsia cutánea se reportó como inespecífica, pero como la sospecha clínica era alta de leishmaniasis, se realizó una reacción de cadena polimerasa de tejido de mucosa nasal que fue reportada positiva por Leishmania panamensis. Por las comorbilidades y el tratamiento del paciente se decidió tratarlo con miltefosine (Impávido(r)).

Miltefosine (Impavido(r)) is an anticancer medicine that has been found highly effective against mucocutaneous and visceral leishmaniasis worldwide, making it a very attractive option for patients with underlying diseases and treatments that contraindicate the use of glucamine antimoniate (Glucantime(r)) or sodium stibogluconate (Pentostam(r)). Here we present the case of a 78 years old male, with a history of type 2 diabetes mellitus, high blood preasure, anticoagulated with warfarin for chronic atrial fibrillation, who started with a solitary cutaneous ulcer of purplish edges on the right ear helix of chronic evolution associated with multiple ulcerations on the nasal mucosa. Skin biopsy was reported as nonspecific, but as clinical suspicion of leishmaniasis was high, a polymerase chain reaction of nasal mucosa tissue was performed for Leishmania with positive results for Leishmania panamensis. Due to comorbidities and the treatment of our patient we decided to use miltefosine (Impavido(r)) for 2 months with very good results.

Humans , Male , Aged , Aged , Antineoplastic Agents , Diabetes Mellitus , Leishmaniasis, Mucocutaneous , Meglumine
Rev. Soc. Bras. Med. Trop ; 49(2): 196-203, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-782098


Abstract: INTRODUCTION: Leishmaniasis is a disease caused by the protozoan Leishmania that resides mainly in mononuclear phagocytic system tissues. Pentavalent antimonials are the main treatment option, although these drugs have toxic side effects and high resistance rates. A potentially alternative and more effective therapeutic strategy is to use liposomes as carriers of the antileishmanial agents. The aims of this study were to develop antimonial drugs entrapped into phosphatidylserine liposomes and to analyze their biological and physicochemical characteristics. METHODS: Liposomes containing meglumine antimoniate (MA) or pentavalent antimony salt (Sb) were obtained through filter extrusion (FEL) and characterized by transmission electron microscopy. Promastigotes of Leishmania infantum were incubated with the drugs and the viability was determined with a tetrazolium dye (MTT assay). The effects of these drugs against intracellular amastigotes were also evaluated by optical microscopy, and mammalian cytotoxicity was determined by an MTT assay. RESULTS: Liposomes had an average diameter of 162nm. MA-FEL showed inhibitory activity against intracellular L. infantum amastigotes, with a 50% inhibitory concentration (IC50) of 0.9μg/mL, whereas that of MA was 60μg/mL. Sb-FEL showed an IC50 value of 0.2μg/mL, whereas that of free Sb was 9μg/mL. MA-FEL and Sb-FEL had strong in vitro activity that was 63-fold and 39-fold more effective than their respective free drugs. MA-FEL tested at a ten-times higher concentration than Sb-FEL did not show cytotoxicity to mammalian cells, resulting in a higher selectivity index. CONCLUSIONS: Antimonial drug-containing liposomes are more effective against Leishmania-infected macrophages than the non-liposomal drugs.

Animals , Organometallic Compounds/pharmacology , Phosphatidylserines/pharmacology , Macrophages, Peritoneal/parasitology , Leishmania infantum/drug effects , Antimony Sodium Gluconate/pharmacology , Meglumine/pharmacology , Antiprotozoal Agents/pharmacology , Organometallic Compounds/chemistry , Phosphatidylserines/chemistry , Cricetinae , Antimony Sodium Gluconate/chemistry , Inhibitory Concentration 50 , Parasitic Sensitivity Tests , Dose-Response Relationship, Drug , Meglumine Antimoniate , Liposomes , Meglumine/chemistry , Mice , Mice, Inbred BALB C , Antiprotozoal Agents/chemistry
Rev. Soc. Bras. Med. Trop ; 47(6): 756-762, Nov-Dec/2014. tab, graf
Article in English | LILACS | ID: lil-732985


Introduction Parenteral antimony-based compounds are still the standard of care for cutaneous leishmaniasis (CL) treatment in many countries, despite their high toxicity. Previous studies showed that oral azithromycin could be an option for CL treatment. The aim of this study was to evaluate efficacy and safety of oral azithromycin (AZ) for CL treatment compared with injectable meglumine antimoniate (MA). Methods This was a randomized, open-label, 2-arm, non-inferiority clinical trial. Treatment-naïve patients with localized CL were treated with MA (15mg/kg/day up to 1,215mg) or AZ (500mg/day) during 20 consecutive days. The primary efficacy end point was a CL cure 90 days after treatment completion. The analysis was performed with intention-to-treat (ITT) and per protocol (PP) analyses. After an anticipated interim analysis, the study was interrupted due to the high failure rate in the azithromycin group. Results Twenty-four volunteers were included in each group. The MA group had a higher cure rate than the AZ group with the ITT and PP analyses, which were 54.2% versus 20.8% [relative risk (RR) 1.97; 95% confidence intervals (95%CI) 1.13-3.42] and 72.2% versus 23.8% (RR 3.03; 95%CI 1.34-6.87), respectively. No unexpected adverse events were observed. Conclusions ...

Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/administration & dosage , Antiprotozoal Agents/administration & dosage , Azithromycin/administration & dosage , Early Termination of Clinical Trials , Leishmaniasis, Cutaneous/drug therapy , Meglumine/administration & dosage , Organometallic Compounds/administration & dosage , Administration, Oral , Brazil , Time Factors , Treatment Failure
Rev. Inst. Med. Trop. Säo Paulo ; 56(5): 439-442, Sep-Oct/2014. graf
Article in English | LILACS | ID: lil-722321


Introduction: Pentavalent antimonials are the first drug of choice in the treatment of tegumentary leishmaniasis. Data on ototoxicity related with such drugs is scarcely available in literature, leading us to develop a study on cochleovestibular functions. Case Report: A case of a tegumentary leishmaniasis patient, a 78-year-old man who presented a substantial increase in auditory threshold with tinnitus and severe rotatory dizziness during the treatment with meglumine antimoniate, is reported. These symptoms worsened in two weeks after treatment was interrupted. Conclusion: Dizziness and tinnitus had already been related to meglumine antimoniate. However, this is the first well documented case of cochlear-vestibular toxicity related to meglumine antimoniate.

Introdução: Antimoniais pentavalentes são os fármacos de primeira escolha no tratamento da leishmaniose tegumentar. Dados de ototoxicidade relacionados a tais fármacos são escassos na literatura, o que nos levou a desenvolver um estudo de funções cócleo-vestibulares. Relato de caso: Relatamos caso de paciente masculino de 78 anos com leishmaniose tegumentar, que apresentou aumento significativo dos limiares auditivos com zumbido e tontura rotatória grave durante o tratamento com antimoniato de meglumina. Os sintomas pioraram até duas semanas após a interrupção do tratamento. Conclusão: Tontura e zumbido já tinham sido associados ao antimoniato de meglumina. Entretanto, este é o primeiro caso bem documentado de toxicidade cócleo-vestibular relacionado ao antimoniato de meglumina.

Aged , Humans , Male , Antiprotozoal Agents/adverse effects , Auditory Threshold/drug effects , Dizziness/chemically induced , Meglumine/adverse effects , Organometallic Compounds/adverse effects , Tinnitus/chemically induced , Audiometry, Pure-Tone , Leishmaniasis, Cutaneous/drug therapy , Severity of Illness Index
Rev. Inst. Med. Trop. Säo Paulo ; 56(4): 361-362, Jul-Aug/2014. graf
Article in English | LILACS | ID: lil-716423


We report a case of a 42 year-old female, who came to a leishmaniasis reference center in Rio de Janeiro, Brazil, presenting a cutaneous leishmaniasis lesion in the right forearm. Treatment with low-dose intramuscular meglumine antimoniate (MA) (5 mg Sb5+/kg/day) was initiated, with improvement after 28 days, although with the development of generalized eczema. After 87 days, the lesion worsened. Patient refused treatment with amphotericin B. MA was then infiltrated in the lesion, in two sessions, resulting in local eczema, with bullae formation; however, twenty days after, both the ulcer and eczema receded. Intralesional administration of MA should be used carefully when previous cutaneous hypersensitivity is detected.

Relatamos caso de paciente de 42 anos atendida em centro de referência em leishmanioses no Rio de Janeiro, Brasil, apresentando lesão de leishmaniose cutânea no antebraço direito. Iniciado tratamento com baixa dose de antimoniato de meglumina (AM) intramuscular (5 mg Sb5+/kg/dia), houve melhora após 28 dias, porém com desenvolvimento de eczema generalizado. Após 87 dias, notou-se piora da lesão. A paciente recusou o tratamento com anfotericina B. Infiltrou-se AM na lesão em duas sessões, resultando em eczema local com bolhas. Entretanto, 20 dias depois, tanto a úlcera quanto o eczema regrediram. A administração intralesional do AM deve ser utilizada com cautela em pacientes com hipersensibilidade cutânea a este fármaco.

Adult , Female , Humans , Antiprotozoal Agents/adverse effects , Drug Eruptions/drug therapy , Eczema/chemically induced , Leishmaniasis, Cutaneous/drug therapy , Meglumine/adverse effects , Organometallic Compounds/adverse effects , Antiprotozoal Agents/administration & dosage , Eczema/drug therapy , Injections, Intralesional , Injections, Intramuscular , Meglumine/administration & dosage , Organometallic Compounds/administration & dosage
Rio de Janeiro; s.n; 2013. xv,92 p. ilus.
Thesis in Portuguese | LILACS | ID: lil-762488


A leishmaniose tegumentar americana é uma doença que acomete a pele e as mucosas das vias aero digestivas superiores. Os antimoniais pentavalentes vêm sendo empregados há muitas décadas como fármacos de primeira linha para o seu tratamento. Pacientes com poucas lesões cutâneas, com impossibilidade de receber medicação parenteral regular ou com sinais de toxicidade importante ao antimonial por via sistêmica, podem ser submetidosao tratamento intralesional com antimoniato de meglumina. Objetivos:descrever a eficácia e a segurança do antimoniato de meglumina administrado por via intralesional, para o tratamento da leishmaniose cutânea. Método: Foi realizado um estudo descritivo, retrospectivo, tipo série de casos, de pacientes atendidos no Laboratório de Vigilância em Leishmanioses do Instituto de Pesquisa Clínica Evandro Chagas – FIOCRUZ, de 2002 até julho de 2011, que tivessem sido tratados para leishmaniose cutânea com aplicação intralesional de antimoniato de meglumina, após tratamento sistêmico com o mesmo fármaco...

American tegumentary leishmaniasis is a disease that affects the skin and mucous membranes of the upper aerodigestive tract. Pentavalent antimonial compounds have been used for decades as a first-line drugs for its treatment.Patients with few skin lesions, with inability to receive parenteral medication regularly or with signs of significant toxicity to antimony systemically, may be subjected to treatment with intralesional meglumine antimoniate. Objectives: Todescribe the efficacy and safety of meglumine antimoniate administered intralesionally, for the treatment of cutaneous leishmaniasis. Methods: We conducted a descriptive, retrospective case series of patients treated at the Leishmaniasis Surveillance Laboratory, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, from 2002 until July2011, which had been treated for cutaneous leishmaniasis with intralesional meglumine antimoniate after systemic treatment with the same drug...

Humans , Injections, Intralesional , Leishmania braziliensis , Leishmaniasis, Cutaneous/therapy , Meglumine
Univ. med ; 53(1): 33-42, ene.-mar. 2012. ilus
Article in Spanish | LILACS | ID: lil-665439


El tratamiento de elección para la leishmaniasis es el antimoniato de meglumina, del cual se han reportado efectos pancreáticos. Se llevó a cabo un estudio con 90 pacientes entre agosto de 2010 y abril de 2011, y se observó la variabilidad de la amilasa al inicio, la mitad y el final del tratamiento con dosis de 20 mg/kg al día. Los promedios fueron: peso, 68±9,1 kg, edad, 24,73±4,45 años, y dosis del medicamento, 28,15±3,97g. El sitio de lesión más frecuente fue en miembros superiores (44,4%). No hubo asociación significativa entre las variables peso, edad y gramos de medicamento. Se presentó alteración en 49,37% a la mitad de tratamiento y en 6,5% al final. Existen diferencias significativas en la amilasa reportada a mitad de tratamiento respecto alas dos tomas (p=0,000). En conclusión, se debe controlar la amilasa sérica, ya que se eleva, especialmente, a mitad de tratamiento...

The treatment of choice for leishmaniasis is meglumine antimoniate, reporting effects at the pancreatic duct. A study with 90 patients between August 2010 and April 2011 found amylase changes at the beginning, middle and end of treatment at doses of 20 mg/kg/day. The averages were: weight, 68 kg±9.1, age 24.73±4.45 years, and 28.15±3.97 g of the drug dose. The site of injury was 44,4% in upperlimbs. No significant association was found between the variables weight, age and treatment programs. Alteration was present in 49,37% inthe middle of treatment and 6,5% at the end. There were significant differences in reported half-amylase treatment on the two doses (p=0.000). In conclusion, control must be performed in serum amylase and rising especially in the middle of treatment...

Leishmaniasis, Cutaneous , alpha-Amylases
Rio de Janeiro; s.n; 2012. xvi,93 p. tab, ilus.
Thesis in Portuguese | LILACS | ID: lil-734200


Pacientes com leishmaniose cutânea (LC) apresentam variada resposta à terapêutica com antimoniais pentavalentes, desde a cura clínica até a falha terapêutica e reativação da doença. Aspectos relacionados ao hospedeiro, aos parasitos, aos diferentes fármacos e aos diferentes esquemas terapêuticos podem influenciar nesse desfecho. No estado do Rio de Janeiro, tem sido relatada resposta terapêutica favorável a baixas doses de antimoniais (5mg Sbv/kg/dia). É possível que esse resultado esteja relacionado a características genéticas das subpopulações de Leishmania braziliensis que circulam nesse Estado. Neste estudo investigou-se a variabilidade genética e a sensibilidade in vitro ao antimoniato de meglumina de amostras de L. braziliensis, comparando isolados obtidos de pacientes com LC respondedores ou não respondedores ao tratamento com 5mg Sbv/Kg/dia. Foram estudadas amostras de pacientes diagnosticados no Laboratório de Vigilância em Leishmanioses (Vigileish) do Instituto de Pesquisa Clínica Evandro Chagas - Fundação Oswaldo Cruz entre 1999 e 2011. Utilizamos uma amostra de conveniência compreendendo 54 isolados recuperados do banco de cepas do Vigileish, as quais foram distribuídas em quatro subgrupos obedecendo a critérios de inclusão: RRJ) Respondedores ao primeiro curso de tratamento, com infecção adquirida no estado do Rio de Janeiro; NRRJ) Não respondedores ao primeiro curso de tratamento, com infecção no estado do Rio de Janeiro; ROE) Respondedores ao tratamento, com infecção adquirida em outros estados brasileiros e NROE) Não respondedores, com infecção em outros estados brasileiros...

A metodologia utilizada compreendeu inicialmente a caracterização das amostras pela técnica de isoenzimas e após, avaliação da sensibilidade ao antimoniato de meglumina por diluição limitante (DL50) utilizando formas promastigotas e análise da variabilidade genética por Low-Stringency Single-Specific-Primer (LSSP-PCR). Dados clínicos e laboratoriais relacionados ao diagnóstico dos pacientes e aos resultados obtidos neste estudo foram analisados estatisticamente por cálculos em Excel e usando o programa GraphPadPrism 5.0. Os níveis da dose letal de 50 por cento (DL50) das amostras variaram, respectivamente, de 1.9 a 6.0 mg/mL e de 2.3 a 6.4 mg/mL para pacientes respondedores ao tratamento e para pacientes não respondedores, e os valores médios para cada grupo apresentaram diferença significativa (p=0,0007). A diferença se manteve quando os grupos foram analisados separadamente por local de origem. Entretanto, não foi possível associar tal resultado a padrões genéticos dos parasitos estudados após análise dos dendrogramas gerados pela técnica de LSSP-PCR. Os valores médios da Intradermorreação de Montenegro (IDRM) foram significativamente maiores em pacientes respondedores (p= 0,0301). É possível que, no grupo estudado, fatores relacionados ao hospedeiro sejam mais importantes para variação da resposta terapêutica que os fatores genéticos do parasito e que o resultado da IDRM possa ser um indicativo de resposta terapêutica na LC...

Humans , Antimony/therapeutic use , Leishmania braziliensis , Leishmaniasis, Cutaneous , Intradermal Tests
Braz. j. vet. res. anim. sci ; 47(3): 218-223, mai.-jun. 2010. tab
Article in Portuguese | LILACS | ID: lil-561195


Aiming to assess the efficacy of the treatment, to verify the occurrence of possible disease relapses and to search for the presence of parasites after the treatment, seven dogs naturally infected by Leishmania sp., were submitted to a treatment with meglumine antimoniate and allopurinol. For this, lymph node and bone marrow aspiration biopsies were carried out at seven moments. After the end of the six-month observation period all dogs were submitted to euthanasia. Then, spleen and liver “imprints” and in vitro cultures were carried out to search for amastigote forms of the parasite. All animals presented remission of the symptoms and during all the observation period no dog presented relapse of the disease, although amastigote forms of the parasite were observed in two of the animals at the end of the experiment. Thus, it was possible to conclude that the treatment promotes clinical healing but it does not eliminate the parasites completely.

Com objetivo de avaliar a eficácia do tratamento, verificar a ocorrência de possíveis recidivas da doença e pesquisar a presença de parasitas após a realização do tratamento, foram utilizados sete cães naturalmente infectados por Leishmania sp., submetidos a tratamento com antimoniato de meglumina e alopurinol. Para tanto, foram realizadas punções biópsias aspirativas de linfonodos e de medula óssea em sete momentos. Após o término dos seis meses de observação, todos os cães foram submetidos à eutanásia e realizados “imprints” e cultivo in vitro do baço e fígado para a pesquisa de formas amastigotas. Todos os animais apresentaram remissão dos sintomas e durante todo o período de observação nenhum cão apresentou recidiva da doença apesar de ter sido observada a presença de formas amastigotas do parasita em dois animais, ao término do experimento. Desta forma, foi possível concluir que o tratamento promove a cura clínica, entretanto não elimina completamente os parasitas.

Animals , Allopurinol/therapeutic use , Leishmaniasis/drug therapy , Meglumine/therapeutic use , Leishmaniasis/veterinary , Treatment Outcome