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1.
Rev. Soc. Bras. Med. Trop ; 54: e0633-2020, 2021. graf
Article in English | LILACS | ID: biblio-1155602

ABSTRACT

Abstract In this study, we present two cases of cutaneous leishmaniasis in patients with end-stage renal disease, who were treated solely with intramuscular pentamidine. In such cases, treatment implies a fine line between therapeutic efficacy and toxicity. This is suggestive of a knowledge gap; however, findings indicate that this is still the fastest and safest alternative to the treatment with antimonials. Also, it can help avoid the side effects that occur upon using antimonials.


Subject(s)
Humans , Leishmaniasis, Cutaneous/complications , Leishmaniasis, Cutaneous/drug therapy , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Antiprotozoal Agents/therapeutic use , Pentamidine/therapeutic use , Renal Dialysis
2.
Rev. Soc. Bras. Med. Trop ; 54: e0514-2020, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155581

ABSTRACT

Abstract A 31-year-old male patient developed an ulcer on the glans penis that evolved for three months without healing. We diagnosed it as leishmaniasis using polymerase chain reaction. No immunosuppression or associated diseases were observed. The patient was treated with meglumine antimoniate that cured the lesion in a month post-treatment. Here, we report this case of cutaneous leishmaniasis lesion at the unusual location of glans penis in an immunocompetent individual. The lesion likely developed due to the bite of a vector, highlighting the need for considering cutaneous leishmaniasis among differential diagnosis of sexually transmitted diseases in areas endemic for leishmaniasis.


Subject(s)
Humans , Male , Adult , Organometallic Compounds/therapeutic use , Leishmaniasis, Cutaneous/diagnosis , Leishmaniasis, Cutaneous/drug therapy , Antiprotozoal Agents/therapeutic use , Brazil , Polymerase Chain Reaction , Meglumine Antimoniate/therapeutic use , Genitalia , Meglumine/therapeutic use
4.
Rev. Soc. Bras. Med. Trop ; 54: e04542020, 2021. tab
Article in English | LILACS | ID: biblio-1155531

ABSTRACT

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.


Subject(s)
Humans , Leishmaniasis, Mucocutaneous/drug therapy , Antiprotozoal Agents/therapeutic use , Brazil , Cost-Benefit Analysis , Meglumine Antimoniate/therapeutic use
5.
Rev. bras. med. fam. comunidade ; 15(42): 2157, 20200210.
Article in Portuguese | LILACS | ID: biblio-1282619

ABSTRACT

Introdução: As enteroparasitoses são foco de investigações científicas no mundo todo. Urbanorumspp. foi reconhecido como parasita em 1994 no Peru, expandindo-se pela América do Sul. Relatado pela primeira vez no Brasil em 2018, Maranhão. Este relato apresenta o segundo caso no estado do Paraná. Relato de caso: Paciente masculino, 56 anos, 75kg, diabético, habitante de São José dos Pinhais, área urbana. Procura atenção primária por dor ao evacuar, tenesmo e cólica abdominal. Nega diarréia, febre, sangue nas fezes e viagem recente. Exame físico abdominal, hemograma e parcial de urina sem alterações. Parasitológico de fezes: Urbanorum spp. Prescrito Nitazoxanida 500mg 12/12h por 3 dias. Paciente retorna com melhora da sintomatologia e parasitológico de controle negativo. Conclusão: Atualmente a escassez de estudos primários prospectivos dificultam o delineamento clínico-epidemiológico e tratamento da parasitose. A disseminação do parasita entre extremos do país em curto intervalo de tempo, aliada à carência de saneamento básico criam um alerta para seu grande potencial epidêmico. Por isso, as políticas de saúde pública devem priorizar ações informativas e preventivas a fim de evitar surtos e complicações. A atenção primária à saúde é fundamental nesse contexto, justamente pela longitudinalidade e abrangência do cuidado.


Background: Enteroparasitosis are the focus of scientific research worldwide. Urbanorum spp. was recognized as a parasite in Peru in 1994, expanding throughout South America. Reported for the first time in Brazil, state of Maranhão, in 2018. This report presents the second case in the state of Paraná. Case report: Male patient, 56 years old, 75kg, diabetic, inhabitant of São José dos Pinhais, urban area, seeks primary care for pain on bowel movement, tenesmus and abdominal cramps. Denies diarrhea, fever, bloody stools, recent trip. Abdominal examination, blood count and partial urine without changes. Stool parasitology: urbanorum spp. Prescribed Nitazoxanide 500mg 12/12h for 3 days. Patient returns with improvement of symptomatology and parasitological negative control. Conclusion:Currently, the scarcity of prospective studies and meta-analyzes make clinical-epidemiological design and treatment of parasitosis difficult. The spread of the parasite between extremes of the country in a short period of time, coupled with the lack of basic sanitation create a warning for its great epidemic potential. Therefore, public health policies should prioritize informative and preventive actions in order to avoid outbreaks and complications. Primary health care is fundamental in this context, precisely because of the longitudinally and comprehensiveness of care.


Introducción: Las enteroparasitosis el punto de enfoque de investigaciones científicas en todo el mundo. Urbanorum spp fue reconocido cómo parásito en 1994 en el Peru, expandiéndose en América do Sul. Relatado por primera vez en Brasil, Maranhão, 2018. Este informe se encuentra en segundo lugar en el estado de Paraná. Relato del caso: Paciente masculino, 56 años, 75 kg, diabético, habitante de São José dos Pinhais, área urbana. Búsqueda atención primaria por dolor al defecar, tenesmo, y dolor abdominal. Nega diarrea, fiebre, sangre en heces o viaje reciente. Examen físico abdominal, hemograma e tests de orina sin modificaciones. Análisis parasitología: urbanorum spp. Prescripto Nitazoxanide 500mg 12/12h durante 3 días. Paciente volvió con alivio sintomático e materia fecal negativo. Conclusión: En la actualidad la escasez de estudios prospectivos y metanálisis dificultan la delineación clínico-epidemiológica y el tratamiento de la parasitosis. La diseminación del parásito entre los extremos del país en un corto período de tiempo, junto con la falta de saneamiento básico, crea una alerta por su gran potencial epidémico. Por lo tanto, las políticas de salud pública deben priorizar las acciones informativas y preventivas para evitar brotes y complicaciones. La atención primaria de salud es fundamental en este contexto, precisamente por la longitudinalidad y la amplitud de la atención.


Subject(s)
Humans , Male , Middle Aged , Protozoan Infections/diagnosis , Abdominal Pain/parasitology , Intestinal Diseases, Parasitic/diagnosis , Protozoan Infections/drug therapy , Intestinal Diseases, Parasitic/drug therapy , Antiprotozoal Agents/therapeutic use
6.
Rev. Soc. Bras. Med. Trop ; 53: e20200091, 2020. graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136875

ABSTRACT

Abstract INTRODUCTION: The drugs currently available for leishmaniasis treatment have major limitations. METHODS: In vitro and in vivo studies were performed to evaluate the effect of a quinoline derivative, Hydraqui (7-chloro-4-(3-hydroxy-benzilidenehydrazo)quinoline, against Leishmania amazonensis. In silico analyses of absorption, distribution, metabolism, excretion, and toxicity (ADMET) parameters were performed. RESULTS: Hydraqui showed significant in vitro anti-amastigote activity. Also, Hydraqui-treated mice exhibited high efficacy in lesion size (48.3%) and parasitic load (93.8%) reduction, did not cause hepatic and renal toxicity, and showed appropriate ADMET properties. CONCLUSIONS: Hydraqui presents a set of satisfactory criteria for its application as an antileishmanial agent.


Subject(s)
Animals , Female , Quinolines/therapeutic use , Leishmania mexicana/drug effects , Leishmaniasis, Cutaneous/drug therapy , Antiprotozoal Agents/therapeutic use , Quinolines/chemistry , Leishmaniasis, Cutaneous/parasitology , Disease Models, Animal , Parasite Load , Mice , Mice, Inbred BALB C
7.
Rev. Soc. Bras. Med. Trop ; 53: e20190139, 2020. graf
Article in English | LILACS | ID: biblio-1057288

ABSTRACT

Abstract INTRODUCTION: Leishmaniasis, a disease caused by a parasite endemic to large areas of tropical and subtropical countries, is a growing public health problem. METHODS: Male BALB/c mice were infected with Leishmania amazonensis and treated with extracts isolated from Annona mucosa. RESULTS: Treated groups had significantly reduced footpad swelling. The group treated intraperitoneally with hexane extract showed footpad swelling similar to groups treated with Pentamidine® and Glucantime®. Groups treated with dichloromethane extract and hexane extract presented the recovering phenotype associated with reduced parasite levels. CONCLUSIONS: Extracts of A. mucosa are promising sources of novel antileishmanial compounds.


Subject(s)
Animals , Male , Plant Extracts/therapeutic use , Leishmaniasis, Cutaneous/drug therapy , Annona/chemistry , Leishmania/drug effects , Antiprotozoal Agents/therapeutic use , Leishmaniasis, Cutaneous/parasitology , Disease Models, Animal , Mice , Mice, Inbred BALB C , Antiprotozoal Agents/isolation & purification
8.
Mem. Inst. Oswaldo Cruz ; 115: e190361, 2020. tab, graf
Article in English | LILACS | ID: biblio-1091244

ABSTRACT

Genes associated with wound healing have been shown to be risk factors for cutaneous leishmaniasis (CL) which is caused by Leishmania braziliensis. In this study, we examined whether the genes previously associated with CL influenced the clinical outcome. Patients were genotyped and retrospectively classified as responders, who were cured with a single course of pentavalent antimony (Sbv), or as refractories, who did not respond to Sbv. Patients characterised as responders showed a stronger response to the leishmanin skin test (LST) when compared to the refractory subjects (p = 0.0003). Furthermore, we observed an association between the FLI1 CC genotype and an increased size of ulcers (p = 0.0170). We suggest that the leishmanin skin test may be a predictive tool for therapeutic outcome and reinforce FLI1 as a potential influencer of susceptibility and lesion size in CL.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Wound Healing/genetics , Leishmaniasis, Cutaneous/genetics , Antimony/therapeutic use , Antiprotozoal Agents/therapeutic use , Skin Tests , Case-Control Studies , Retrospective Studies , Leishmaniasis, Cutaneous/pathology , Leishmaniasis, Cutaneous/drug therapy , Genetic Predisposition to Disease , Polymorphism, Single Nucleotide , Genotype , Middle Aged
9.
An. bras. dermatol ; 94(3): 355-357, May-June 2019. graf
Article in English | LILACS | ID: biblio-1011111

ABSTRACT

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.


Subject(s)
Humans , Male , Adult , Leishmaniasis, Cutaneous/complications , Leishmaniasis, Cutaneous/drug therapy , Renal Insufficiency, Chronic/complications , /adverse effects , Antiprotozoal Agents/adverse effects , Brazil , Amphotericin B/therapeutic use , Renal Dialysis , Leishmaniasis, Cutaneous/pathology , Drug-Related Side Effects and Adverse Reactions , Antiprotozoal Agents/therapeutic use
10.
Braz. j. infect. dis ; 23(2): 124-129, Mar.-Apr. 2019.
Article in English | LILACS | ID: biblio-1011578

ABSTRACT

ABSTRACT Human visceral leishmaniasis is a growing anthropozoonosis in Brazil, and particularly in the southern region of the country. It is an infectious disease transmitted to humans, dogs and other animals in urban and rural areas of the Americas, mainly due to the bite of Lutzomya longipalpis infected with Leishmania infantum. This article aims to portray the current epidemiological situation of the human visceral leishmaniasis arrival in Porto Alegre city, located in the southern region of Brazil. It is a descriptive study, a case series and a critical review. Six human cases with human visceral leishmaniasis were notified by the date of conclusion of the study, all human visceral leishmaniasis cases were diagnosed at late stage, leading to four deaths.


Subject(s)
Humans , Animals , Male , Female , Infant , Child, Preschool , Adult , Aged, 80 and over , Dogs , Young Adult , Leishmaniasis, Visceral/epidemiology , Time Factors , Brazil/epidemiology , Dog Diseases , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/therapy , Antiprotozoal Agents/therapeutic use
11.
An. bras. dermatol ; 94(1): 9-16, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-983744

ABSTRACT

Abstract: Disseminated leishmaniasis is a severe and emerging form of American tegumentary leishmaniasis. Disseminated leishmaniasis is defined by the presence of more than 10 polymorphic cutaneous lesions, distributed over more than two noncontiguous parts of the body. Nasal mucosal involvement is observed in almost half of cases. Disseminated leishmaniasis patients present with a decreased production of Th1 cytokines in the peripheral blood due to the attraction of leishmania- activated T cells to the multiple cutaneous lesions. Disseminated leishmaniasis development is poorly understood and is related to a complex network involving environmental, host immune response, and parasite factors, in which L. braziliensis polymorphism plays an important role. Disseminated leishmaniasis is a challenging disease to cure, presenting a high failure rate of 75% to pentavalent antimony therapy. Despite its importance and severity, this form of American tegumentary leishmaniasis has been poorly studied and documented, deserving greater attention from professionals working in endemic areas.


Subject(s)
Humans , Leishmania braziliensis , Leishmaniasis, Cutaneous/pathology , Leishmaniasis, Cutaneous/drug therapy , Amphotericin B/therapeutic use , Treatment Outcome , Leishmaniasis, Cutaneous/immunology , Antiprotozoal Agents/therapeutic use
12.
Rev. Soc. Bras. Med. Trop ; 52: e20180236, 2019. graf
Article in English | LILACS | ID: biblio-977116

ABSTRACT

Abstract 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.


Subject(s)
Humans , Male , Pentamidine/therapeutic use , Leishmania braziliensis/drug effects , Leishmaniasis, Mucocutaneous/drug therapy , Antiprotozoal Agents/therapeutic use , Treatment Outcome , Middle Aged
13.
Rev. Soc. Bras. Med. Trop ; 51(6): 769-780, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-977099

ABSTRACT

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.


Subject(s)
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
14.
An. bras. dermatol ; 93(3): 347-355, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-949892

ABSTRACT

Abstract: BACKGROUND: Pentavalent antimonials remain as the standard drugs in the treatment of cutaneous leishmaniosis. The high cost, difficult administration, long treatment time, toxicity and increasing morbidity are factors that limit the use of these drugs. OBJECTIVES: To describe the response to radiofrequency thermotherapy in the treatment of localized cutaneous leishmaniasis in Brazil, and to evaluate its safety and tolerability. METHODS: We conducted a non-comparative open trial with a total of 15 patients confirmed to have cutaneous leishmaniasis on parasitological examination. A single radiofrequency thermotherapy session at 50ºC for 30 seconds was applied to the lesion and its edges. In patients with more than one lesion, only the largest one was treated initially. If after 30 days there was no evidence of healing, the smaller lesion was also treated with thermotherapy. Clinical cure was defined as visible healing for three months after treatment. The patients were followed-up for six months and there was no follow-up loss. RESULTS: Of all 23 lesions, only two evolved to complete healing without the need of treatment. Of 21 lesions, 18 (85.7%) achieved full healing. The main observed side effects were itching, burning sensation, pain and blisters. STUDY LIMITATIONS: Sample with a small number of patients and short follow-up. CONCLUSION: Thermotherapy can be considered a therapeutic alternative in localized cutaneous leishmaniasis, especially in cases of single cutaneous lesions and with formal contraindications to conventional treatment with pentavalent antimonials.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Leishmaniasis, Cutaneous/therapy , Hyperthermia, Induced/methods , Antiprotozoal Agents/therapeutic use , Radio Waves , Brazil , Drug Resistance , Confidence Intervals , Treatment Outcome , Leishmaniasis, Cutaneous/pathology , Leishmaniasis, Cutaneous/drug therapy , Controlled Before-After Studies , Hyperthermia, Induced/adverse effects , Hyperthermia, Induced/standards , Antiprotozoal Agents/adverse effects
15.
Rev. Soc. Bras. Med. Trop ; 51(3): 318-323, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-957424

ABSTRACT

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.


Subject(s)
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
16.
Rev. Assoc. Med. Bras. (1992) ; 64(3): 281-289, Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-896453

ABSTRACT

Summary Leishmaniasis is a disease with ample clinical spectrum and epidemiological diversity and is considered a major public health problem. This article presents an overview of the transmission cycles, host-parasite interactions, clinical, histological and immunological aspects, diagnosis and treatment of various forms of the human disease.


Resumo A leishmaniose representa um complexo de doenças com amplo espectro clínico e diversidade epidemiológica, sendo considerada um grande problema de saúde pública. O presente artigo apresenta uma revisão geral sobre os ciclos de transmissão, as interações parasito-hospedeiro, os aspectos clínicos, histopatológicos e imunológicos, o diagnóstico e o tratamento das diversas formas da doença humana.


Subject(s)
Humans , Animals , Leishmaniasis/epidemiology , Psychodidae/parasitology , Brazil/epidemiology , Leishmaniasis/physiopathology , Leishmaniasis/drug therapy , Host-Parasite Interactions/physiology , Leishmania/physiology , Antiprotozoal Agents/therapeutic use
17.
Braz. j. infect. dis ; 22(2): 92-98, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-951638

ABSTRACT

ABSTRACT Introduction: Visceral Leishmaniasis is the most severe form of disease caused by the Leishmania donovani complex, with significant morbidity and mortality in developing countries. Worse outcomes occur among HIV-positive individuals coinfected with Leishmania. It is unclear, however, if there are significant differences on presentation between Visceral Leishmaniasis patients with or without HIV coinfection. Methods: We reviewed medical records from adult patients with Visceral Leishmaniasis treated at a reference healthcare center in Fortaleza - Ceará, Brazil, from July 2010 to December 2013. Data from HIV-coinfected patients have been abstracted and compared to non-HIV controls diagnosed with Visceral Leishmaniasis in the same period. Results: Eighty one HIV-infected patients and 365 controls were enrolled. The diagnosis in HIV patients took significantly longer, with higher recurrence and death rates. Kala-azar's classical triad (fever, constitutional symptoms and splenomegaly) was less frequently observed in Visceral Leishmaniasis-HIV patients, as well as jaundice and edema, while diarrhea was more frequent. Laboratory features included lower levels of hemoglobin, lymphocyte counts and liver enzymes, as well as higher counts of blood platelets and eosinophils. HIV-infected patients were diagnosed mainly through amastigote detection on bone marrow aspirates and treated more often with amphotericin B formulations, whereas in controls, rK39 was the main diagnostic tool and pentavalent antimony was primarily used for treatment. Conclusions: Clinical and laboratory presentation of Visceral Leishmaniasis in HIV-coinfected patients may differ from classic kala-azar, and these differences may be, in part, responsible for the delay in diagnosing and treating leishmaniasis, which might lead to worse outcomes.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , AIDS-Related Opportunistic Infections/diagnosis , Leishmaniasis, Visceral/diagnosis , Brazil/epidemiology , Amphotericin B , Cross-Sectional Studies , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/epidemiology , Diagnosis, Differential , Coinfection/parasitology , Coinfection/virology , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/virology , Antiprotozoal Agents/therapeutic use
18.
Rev. chil. infectol ; 35(5): 612-616, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-978078

ABSTRACT

Resumen La leishmaniasis es una infección producida por protozoos del género Leishmania, transmitida por insectos hematófagos. La forma de presentación más frecuente es la leishmaniasis cutánea (LC), en la cual se observan úlceras crónicas e indoloras, usualmente localizadas en el sitio de la picadura del insecto. El diagnóstico y tratamiento de esta enfermedad son especialmente desafiantes en zonas no endémicas como nuestro país, requiriendo el uso de diversas técnicas de laboratorio y el apoyo de expertos. Se reporta el caso clínico importado de un varón de 42 años con LC causada por L. braziliensis con respuesta exitosa al tratamiento con anfotericina B liposomal.


Leishmaniasis is an infection caused by protozoa of the genus Leishmania sp. and transmitted by sandfly vectors. Cutaneous leishmaniasis (CL) is the most frequent form of presentation. Clinically, chronic and painless ulcers are observed, which usually occur at the site of the sandfly bite. The diagnosis and treatment of this disease is specially challenging in non-endemic countries such as Chile, requiring the use of diverse laboratory techniques as well as the support of expert physicians. Herein we report an imported case of a healthy 42-year-old male with CL caused by L. braziliensis with successful response to liposomal amphotericin B.


Subject(s)
Humans , Male , Adult , Amphotericin B/therapeutic use , Leishmaniasis, Cutaneous/drug therapy , Antiprotozoal Agents/therapeutic use , Treatment Outcome
19.
Rev. Soc. Bras. Clín. Méd ; 15(2): 116-119, 20170000. ilus
Article in Portuguese | LILACS | ID: biblio-875565

ABSTRACT

Apesar de não haver caso autóctone na Região Sudeste, a leishmaniose visceral é encontrada em pacientes que migram de regiões endêmicas. Como é uma doença que, se não reconhecida e conduzida adequadamente, apresenta alta mortalidade, realizamos uma revisão bibliográfica e destacamos, com o relato deste caso, a importância de a incluirmos no diagnóstico diferencial de hepatoesplenomegalia febril ainda na avaliação clínica inicial, pois o retardo no diagnóstico piora o prognóstico e a sobrevida do paciente, sendo sumária a introdução de terapêutica apropriada o mais breve possível.(AU)


Although there is no autochthonous case finding in the Southeast Region, visceral leishmaniasis is found in patients migrating from endemic areas. Because it is a disease that, if not properly recognized and treated, presents high mortality, we performed a bibliographic review and highlight, with the report of this case, the importance of including it in the differential diagnosis of febrile hepatosplenomegaly in the initial clinical evaluation. The late diagnosis worsens the patient's prognosis and survival, and the introduction of appropriate therapeutics should be made as soon as possible.(AU)


Subject(s)
Humans , Male , Young Adult , Antiprotozoal Agents/therapeutic use , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/epidemiology , Liver Diseases, Parasitic/diagnosis , Splenomegaly/diagnosis , Brazil/epidemiology , Diagnosis, Differential
20.
Rev. Soc. Bras. Med. Trop ; 50(4): 478-482, July-Aug. 2017. tab
Article in English | LILACS | ID: biblio-896990

ABSTRACT

Abstract INTRODUCTION: The drugs available for visceral leishmaniasis (VL) treatment in Brazil have specific characteristics in terms of operability, effectiveness, toxicity, and cost. The aim of this study was to estimate the direct costs of therapies recommended by the Ministry of Health (MH) for VL treatment in Brazil. METHODS: The analytical perspective used was that adopted by the Brazilian Public Health System. Three drugs and four regimens were included: 1) N-methyl glucamine antimoniate intramuscularly at 20mg per kg per day for 30 days; 2) N-methyl glucamine antimoniate intravenously at 20mg per kg per day for 30 days; 3) amphotericin B deoxycholate at 1mg per kg per day for 21 days; and 4) liposomal amphotericin B at 3mg per kg per day for a 7 days treatment. RESULTS: The estimated direct costs of treatment for an adult patient using N-methylglucamine antimoniate administered via the intramuscular and intravenous routes were USD 418.52 and USD 669.40, respectively. The estimated cost of treatment with amphotericin B deoxycholate was USD 1,522.70. Finally, the estimated costs of treatment with liposomal amphotericin B were USD 659.79, and USD 11,559.15 using the price adopted by the WHO and the Drug Regulation Board, respectively. CONCLUSIONS: This analysis indicates the economic feasibility of replacing N-methyl glucamine antimoniate with liposomal amphotericin B, which allows a shorter treatment period with less toxicity compared with other treatments, provided that the purchase value used by the WHO and transferred to the MH is maintained.


Subject(s)
Humans , Health Care Costs/statistics & numerical data , Leishmaniasis, Visceral/drug therapy , Antiprotozoal Agents/economics , Organometallic Compounds/economics , Organometallic Compounds/therapeutic use , Brazil , Amphotericin B/economics , Amphotericin B/therapeutic use , Clinical Protocols , Deoxycholic Acid/economics , Deoxycholic Acid/therapeutic use , Drug Combinations , Meglumine Antimoniate , Leishmaniasis, Visceral/economics , Meglumine/economics , Meglumine/therapeutic use , Antiprotozoal Agents/therapeutic use
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