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Rev. Soc. Bras. Med. Trop ; 54: e20200208, 2021. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1143878


Abstract Post-kala-azar dermal leishmaniasis is a skin disorder occurring in 5-10% of visceral leishmaniasis patients after treatment with miltefosine,the first-line drug for this skin disorder. We reported a case of acute anterior uveitis,a rare adverse effect, experienced by a patient treated with miltefosine for post-kala-azar dermal leishmaniasis. This adverse effect developed after 15 days of miltefosine consumption, and the patient himself discontinued the treatment. The ophthalmic complication was completely resolved with antibiotics and steroid eye drops. After recovery from the ophthalmic complication, the patient was successfully treated with liposomal amphotericin B for the skin lesions.

Humans , Uveitis/chemically induced , Uveitis/drug therapy , Leishmaniasis, Cutaneous/drug therapy , Leishmaniasis, Visceral/complications , Leishmaniasis, Visceral/drug therapy , Antiprotozoal Agents/adverse effects , Phosphorylcholine/analogs & derivatives
Rev. Soc. Bras. Med. Trop ; 54: e0748-2020, 2021. graf
Article in English | LILACS | ID: biblio-1155522


Abstract Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania spp. The recurrence of the disease occurs, in general, in patients with decreased or loss of T-cell function, whether due to the use of corticosteroids, immunosuppressive disease, or another cause. In some cases, splenectomy may be a therapeutic option. However, the effectiveness of splenectomy is not well defined. This report describes the evolution of a pediatric patient with seven recurrences of VL, who relapsed post-surgery after drug therapy and splenectomy.

Humans , Child , Leishmania , Leishmaniasis, Visceral/drug therapy , Recurrence , Splenectomy
Rev. Soc. Bras. Med. Trop ; 52: e20180233, 2019.
Article in English | LILACS | ID: biblio-985157


Abstract Visceral leishmaniasis (VL) in pregnant is considered rare. We present the case of a woman with 24 gestational weeks presenting fever, hepatosplenomegaly, pancytopenia, and inversion of albumin/globulin ratio. Anti-rK39 was positive and amastigotes were visualized on myelogram. Treatment with LAmB showed disease improvement. The newborn was born healthy at term, with delivery performed without complications. As VL in pregnancy can progress to death and complications for the mother-fetus binomial, inclusion of VL in the differential diagnosis of patients from endemic areas with compatible clinical picture is mandatory. Treatment with LAmB demonstrates safety and high cure rates in pregnancy.

Humans , Female , Pregnancy , Adolescent , Pregnancy Complications, Parasitic/diagnosis , Leishmaniasis, Visceral/diagnosis , Brazil , Pregnancy Outcome , Pregnancy Complications, Parasitic/drug therapy , Leishmaniasis, Visceral/drug therapy
Rev. Soc. Bras. Med. Trop ; 52: e20180272, 2019. tab, graf
Article in English | LILACS | ID: biblio-1041550


Abstract INTRODUCTION: Visceral leishmaniasis (VL) is fatal if not diagnosed and treated. This study aimed to estimate the cost-effectiveness of diagnostic-therapeutic alternatives for VL in Brazil. METHODS: A decision model estimated the life expectancy and costs of six diagnostic-therapeutic strategies. RESULTS: IT LEISH + liposomal amphotericin B emerged the best option, presenting lower costs and higher effectiveness. DAT-LPC + liposomal amphotericin B showed an incremental cost-effectiveness ratio of US$ 326.31 per life year. CONCLUSIONS: These findings indicate the feasibility of incorporating DAT and designating liposomal amphotericin B as the first-line drug for VL in Brazil.

Humans , Amphotericin B/economics , Cost-Benefit Analysis/statistics & numerical data , Leishmaniasis, Visceral/economics , Meglumine/economics , Antiprotozoal Agents/economics , Brazil , Coombs Test/economics , Amphotericin B/administration & dosage , Sensitivity and Specificity , Fluorescent Antibody Technique, Indirect/economics , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/drug therapy , Meglumine/administration & dosage , Antiprotozoal Agents/administration & dosage
Rev. Soc. Bras. Med. Trop ; 51(3): 393-396, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-957422


Abstract Visceral leishmaniasis is a systemic disease that is potentially severe and endemic in Brazil. It clinically manifests as fever, weight loss, swelling, hepatosplenomegaly, paleness, and edema. In this study, we discuss a case of a 1-year-old child diagnosed with refractory visceral leishmaniasis after being treated with liposomal amphotericin B in two distinct occasions. Considering the persistent clinical features and weak response to conventional treatment, a combination therapy with liposomal amphotericin B (ambisome), n-methylglucamine antimoniate (glucantime), and pentamidine isethionate was initiated, and response to treatment was good.

Humans , Male , Infant , Organometallic Compounds/administration & dosage , Pentamidine/administration & dosage , Amphotericin B/administration & dosage , Leishmaniasis, Visceral/drug therapy , Meglumine/administration & dosage , Antiprotozoal Agents/administration & dosage , Drug Therapy, Combination , Meglumine Antimoniate
Braz. j. infect. dis ; 22(2): 92-98, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-951638


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.

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
Rev. salud pública ; 20(1): 89-93, ene.-feb. 2018. tab
Article in Spanish | LILACS | ID: biblio-962097


RESUMEN Objetivos Describir las características epidemiológicas, clínicas y el tratamiento de niños con leishmaniasis visceral en Neiva, Huila. Metodologia Se realizó un estudio descriptivo del brote de leshmaniasis visceral en niños de la zona urbana de Neiva, Huila, entre los meses de abril a junio de 2012. Resultados Se presentaron siete casos, en niños menores de cinco años, con fiebre prolongada, hepato-esplenomegalia, anemia severa y leucopenia. Cinco ingresaron con trombocitopenia severa, sin manifestaciones hemorrágicas. Seis pacientes recibieron manejo de primera línea con miltefosine, cinco presentaron fracaso terapéutico y se escalonó tratamiento a anfotericina B, de los cuales dos recibieron anfotericina liposomal y tres anfotericina deoxicolato. El principal vector identificado fue la Lutzomyia gomezi y los reservoirios indentifiacados fueron caninos. Conclusión Se describe el primer brote de leishmaniasis visceral en zona urbana, en población pediátrica sin casos de mortalidad. La mayoría de los casos con buena respuesta a Anfotericina B.(AU)

ABSTRACT Objectives To describe the epidemiology, clinical characteristics and treatment of children with visceral Leishmaniasis in Neiva- Huila, from April to June 2012. Methodology We performed a descriptive study of an outbreak of visceral leshmaniasis in children from the urban area of Neiva. Results There were seven cases in children younger than five years. All of them had prolonged fever, hepato-splenomegaly, severe anemia and leukopenia. Five were admitted with severe thrombocytopenia, without hemorrhagic manifestations. Six patients received first-line treatment with miltefosine, five of them had treatment failure requirirng therapy escalation to amphotericin B, two received liposomal amphotericin B and three deoxycholate amphotericin B. The main vector identified was the Lutzomyia gomezi and its main reservoir were canines. Conclusion We describe the first visceral leishmaniasis outbreak in children living in an urban area, with no mortality. Most of the cases had a good response to amphotericin B.(AU)

Humans , Infant, Newborn , Infant , Child, Preschool , Amphotericin B/therapeutic use , Disease Outbreaks , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/epidemiology , Epidemiology, Descriptive , Colombia/epidemiology
Rev. Soc. Bras. Med. Trop ; 50(5): 670-674, Sept.-Oct. 2017. tab
Article in English | LILACS | ID: biblio-1041424


Abstract INTRODUCTION: This study aimed to draw clinical and epidemiological comparisons between visceral leishmaniasis (VL) and VL associated with human immunodeficiency virus (HIV) infection. METHOD: Retrospective study. RESULTS: Of 473 cases of VL, 5.5% were coinfected with HIV. The highest proportion of cases of both VL and VL/HIV were found among men. A higher proportion of VL cases was seen in children aged 0-10 years, whereas coinfection was more common in those aged 18-50 years. CONCLUSIONS: VL/HIV coinfected patients presented slightly differently to and had a higher mortality rate than those with VL only.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , HIV Infections/epidemiology , Coinfection/epidemiology , Leishmaniasis, Visceral/epidemiology , Recurrence , Socioeconomic Factors , Brazil/epidemiology , HIV Infections/physiopathology , HIV Infections/drug therapy , Incidence , Retrospective Studies , Age Factors , Treatment Outcome , Sex Distribution , Age Distribution , Coinfection/physiopathology , Coinfection/drug therapy , Leishmaniasis, Visceral/physiopathology , Leishmaniasis, Visceral/drug therapy , Middle Aged
Rev. Soc. Bras. Med. Trop ; 50(4): 478-482, July-Aug. 2017. tab
Article in English | LILACS | ID: biblio-896990


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.

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
Mem. Inst. Oswaldo Cruz ; 112(8): 561-568, Aug. 2017. graf
Article in English | LILACS | ID: biblio-894865


BACKGROUND Visceral leishmaniasis (VL) caused by Leishmania infantum is characterised by the loss of the ability of the host to generate an effective immune response. Chemokines have a direct involvement in the pathogenesis of leishmaniasis, causing a rapid change in the expression of these molecules during infection by Leishmania. OBJECTIVES Herein, it was investigated the role of CXCL10 in controlling infection by L. infantum. METHODS RAW 264.7 macrophages were infected with L. infantum in vitro and treated or not with CXCL10 (25, 50 and 100 ng/mL). Parasite load, as well as nitric oxide (NO), IL-4 and IL-10 production were assessed at 24 and 48 h after infection. In vivo, BALB/c mice were infected and treated or not with CXCL10 (5 μg/kg) at one, three and seven days of infection. Parasite load, IFN-g, IL-4, TGF-β and IL-10 were evaluated one, seven and 23 days post treatment. FINDINGS In vitro, CXCL10 reduced parasitic load, not dependent on NO, and inhibited IL-10 and IL-4 secretion. In vivo, CXCL10 was able to reduce the parasite load in both liver and spleen, four weeks after infection, representing a higher decrease in the number of parasites in these organs, also induced IFN-γ at day 23 after treatment, correlating with the decrease in parasite load, and reduced IL-10 and TGF-β. MAIN CONCLUSIONS This study suggests a partial protective role of CXCL10 against L. infantum, mediated by IFN-g, not dependent on NO, and with suppression of IL-10 and TGF-β. These data may provide information for the development of new approaches for future therapeutic interventions for VL.

Animals , Male , Mice , Organ Size/physiology , Interleukin-4/biosynthesis , Interleukin-10/biosynthesis , Leishmania infantum , Chemokine CXCL10/therapeutic use , Leishmaniasis, Visceral/immunology , Leishmaniasis, Visceral/parasitology , Leishmaniasis, Visceral/drug therapy , Liver/pathology , Macrophages/drug effects , Cytokines/immunology , Interferon-gamma/analysis , Mice, Inbred BALB C
Rev. Soc. Bras. Med. Trop ; 50(1): 67-74, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-842815


ABSTRACT INTRODUCTION Despite their high toxicity, antimonials and amphotericin B deoxycholate are commonly used for treating visceral leishmaniasis (VL). Few studies showing conflictive data about their efficacy and adverse events in pediatric population are available. This study aimed to evaluate efficacy and safety of amphotericin B deoxycholate vs. that of N-methylglucamine antimoniate in treating pediatric VL in Brazil. METHODS This was a randomized, open-label, 2-arm and controlled pilot clinical trial. Treatment naïve children and adolescents with VL without signs of severe illness were treated with N-methylglucamine antimoniate (20mg/kg/day for 20 days) or amphotericin B deoxycholate (1 mg/kg/day for 14 days). All patients were diagnosed with positive direct examination and/or positive PCR for Leishmania spp. performed in bone marrow samples. The primary efficacy end-point was VL cure determined after 180 days of completion of treatment. The analysis was performed using intention-to-treat (ITT) and per protocol (PP) analyses. RESULTS In total, 101 volunteers were assessed. Efficacy was similar for both groups. The antimonial (n=51) and amphotericin B groups (n=50) had a cure rate of 94.1% and 100%, and 94% and 97.9% according to ITT and PP analyses, respectively. All patients reported adverse events (AE). Serious AE incidence was similar in both groups. Five individuals were excluded from the study because of severe adverse events. CONCLUSIONS N-methylglucamine antimoniate and amphotericin B deoxycholate have similar efficacy and adverse events rate in pediatric patients with VL.

Humans , Male , Female , Child, Preschool , Child , Organometallic Compounds/therapeutic use , Amphotericin B/therapeutic use , Deoxycholic Acid/therapeutic use , Leishmaniasis, Visceral/drug therapy , Meglumine/therapeutic use , Antiprotozoal Agents/therapeutic use , Organometallic Compounds/adverse effects , Pilot Projects , Amphotericin B/adverse effects , Treatment Outcome , Deoxycholic Acid/adverse effects , Drug Combinations , Meglumine Antimoniate , Meglumine/adverse effects , Antiprotozoal Agents/adverse effects
São Paulo; s.n; s.n; 2017. 109p tab, graf.
Thesis in English | LILACS | ID: biblio-876377


Leishmaniases is a group of diseases caused by parasites of the genus Leishmania. The estimated number of deaths from visceral leishmaniases ranges from 20,000 to 50,000 annually. The most common treatment over the past 60 years has been pentavalent antimonials. Besides the doubtful effectiveness, they present several disadvantages such as the need for parenteral administration, large doses, long treatment, severe toxicity and parasite resistance. Buparvaquone (BPQ), a drug used for veterinary treatment of theileriosis, showed promising activity against Leishmania spp. However, due to its low aqueous solubility and bioavailability, it has failed in in vivo tests. The use of nanotechnologies has the potential to overcome these drawbacks due to the following advantages: increase in drug water-solubility, increase in therapeutic efficacy and treatment toxicity reduction. Therefore, the present work aimed the development, optimization, physical-chemical evaluation and in vitro performances of nanostructured lipid carriers (NLC) for BPQ encapsulation. The NLC preparation was performed by high pressure homogenization, and surface response and factorial design were applied to formulation optimization. In vitro dissolution profiles were evaluated in phosphate buffer pH 7.4 with tween 80 0.07% w/v or sodium dodecyl sulfate 1% w/v and simulated body fluid pH 7.4. Cytotoxicity was evaluated in mouse peritoneal macrophages and leishmanicidal activity in L. infantum amastigotes. Six optimized NCL were prepared and they showed solubility improvement from 1.5- fold to 611-fold when compared with free BPQ, depending on the formulation and medium. Dissolution profiles showed the NLC formulation suitability for BPQ regarding oral administration, the release could reach 83.29% of a 4mg dose in 30 minutes for formulation of 175.1 nm, while the free drug could be dissolved only 2.89% of the same dose after 4 hours. Moreover, formulation of 230.7 nm showed 81.42% of drug release in in phosphate buffer pH 7.4 with dodecyl sulfate 1.0% w/v after 30 minutes, while BPQ did not dissolved. Cytotoxicity assay showed the safety of all formulations. The iv CC50 values were close to 500 µM, while the IC50 against amastigotes was only 456.5 nM for free BPQ. Developed NLCs showed an increase in IC50 from 2.0 to 3.1-fold when compared to free drug in the in vitro leishmanicidal evaluation. Therefore, the NLC containing BPQ are a promising alternative for the treatment of leishmaniases as oral and parenteral drug dosage forms. Additionally, they have a potential use for lymphatic targeted drug delivery, which can be an innovative approach for this neglected disease.

Leishmanioses são um grupo de doenças causadas por parasitas do gênero Leishmania. O número estimado de óbitos por leishmaniose visceral varia entre 20.000 e 50.000 por ano. O tratamento mais comum nos últimos 60 anos tem sido os antimônios pentavalentes. Além da eficácia duvidosa, eles apresentam várias desvantagens, como a necessidade de administração parenteral, altas doses, tratamento prolongado, toxicidade severa e resistência parasitária. Buparvaquona (BPQ), um fármaco usado para tratamento veterinário da teileriose, mostrou atividade promissora contra Leishmania donovani. No entanto, devido à sua baixa solubilidade e biodisponibilidade aquosa, falhou em testes in vivo. O uso das nanotecnologias tem o potencial de superar esses obstáculos devido às seguintes vantagens: aumento da solubilidade em água, aumento da eficácia terapêutica e redução da toxicidade do tratamento. Portanto, o presente trabalho objetivou o desenvolvimento, otimização, avaliação físico-química e avaliação do desempenho in vitro de carreadores lipídicos nanoestruturados (NLC) para o encapsulação da BPQ. A preparação do NLC foi realizada por homogeneização de alta pressão e superfície de resposta e planejamento fatorial foram aplicados à otimização das formulações. Os perfis de dissolução in vitro foram avaliados em tampão fosfato pH 7.4 com tween 80 a 0.07% p/v ou dodecilsulfato de sódio 1.0% p/v e fluido corporal simulado pH 7.4. A citotoxicidade foi avaliada em macrófagos peritoneais de camundongos e atividade leishmanicida em amastigotas de L. infantum. Foram preparados quatro NCL otimizados e mostraram melhora da solubilidade de 1,5 a 611 vezes quando comparado com a BPQ livre, dependendo da formulação e do meio. Os perfis de dissolução mostraram a adequação da formulação NLC para BPQ em relação à administração oral. A dissolução pode atingir 83,29% de uma dose de 4.0 mg em 30 minutos para a formulação de 175,1 nm, enquanto o fármaco livre dissolveu apenas vi 2,89% da mesma dose após 4 horas. Além disso, a formulação de 230,7 nm mostrou 81,42% de liberação do fármaco em tampão fosfato pH 7.4 com dodecil sulfato de sódio 1.0% p/v após 30 minutos, enquanto o BPQ não se dissolveu. O teste de citotoxicidade mostrou a segurança de todas as formulações. Os valores CC50 foram próximos de 500 µM, enquanto o IC50 em amastigotas foi de apenas 456,5 nM para BPQ livre. Os NLC desenvolvidos mostraram um aumento no IC50 de 2,0 a 3,1 vezes quando comparado ao;fármaco livre na avaliação leishmanicida in vitro. Logo, as NLC contendo BPQ são uma alternativa promissora para o tratamento de leishmanioses como formas farmacêuticas oral e parenteral. Além disso, eles têm um uso potencial para a sítio-específico ao sistema linfático, o que pode ser uma abordagem inovadora para esta doença negligenciada.

Animals , Male , Female , Mice , Leishmaniasis, Visceral/drug therapy , Veterinary Drugs/analysis , Leishmania donovani/classification , Nanostructures/statistics & numerical data , Nanotechnology , Neglected Diseases/classification
Ciênc. saúde coletiva ; 21(2): 621-628, Fev. 2016.
Article in English | LILACS | ID: lil-773557


Resumo O presente estudo buscou, a partir do referencial teórico metodológico da pesquisa qualitativa, investigar a percepção, sobre a leishmaniose visceral (LV), de atores sociais diretamente envolvidos com a prevenção e controle da doença. A partir da realização de 38 entrevistas semiestruturadas com moradores e grupo focal com 18 agentes de saúde, de município endêmico para LV, foram coletados depoimentos que, tratados pela Análise de Conteúdo, evidenciaram lacunas, desafios e perspectivas do controle e prevenção da doença. A população associava a LV ao cão, reconhecia sua corresponsabilidade no enfrentamento da doença e demandava informação. Os agentes de saúde identificavam o saneamento ambiental como fator imprescindível para prevenção da LV. Entre as lacunas observamos fragilidade nas informações sobre a doença e culpabilização do indivíduo pela não adesão a medidas, sobretudo, de manejo ambiental. Provavelmente, abordagens que destaquem o papel do ambiente como promotor de saúde, em detrimento da prescrição pontual de medidas ambientais específicas contra LV, constitui perspectiva de superação dessas lacunas. Entendemos que o principal desafio para o fortalecimento da prevenção e controle seja a construção participativa e dialógica dessas abordagens entre profissionais de saúde e população.

Abstract Based on theoretical qualitative research reference methodology, this study sought to investigate the perception of visceral leishmaniasis (VL) by social actors directly involved in the prevention and control of the disease. Thirty-eight semi-structured interviews were conducted with residents, focus groups were staged with 18 health workers in an endemic VL area and depositions were collected, which after being processed by content analysis revealed shortcomings and challenges. The population associated VL with dogs, acknowledged their co-responsibility in tackling the disease and demanded information. Health workers identified environmental sanitation as an essential factor for VL prevention. Among the shortcomings, the lack of information about the disease and culpability of the individual because of non-adherence to prevention measures were observed, especially environmental management. Probably, approaches emphasizing the role of the environment as a health promotion agent and the timely definition of specific environmental measures against VL, constitute a prospect for overcoming these shortcomings. The consensus is that the main challenge for enhancing the prevention and control might be the participatory and dialogical construction of these approaches between health professionals and the population.

Humans , Animals , Dogs , Health Knowledge, Attitudes, Practice , Health Personnel , Leishmaniasis, Visceral , Environment , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/prevention & control , Sanitation
An. bras. dermatol ; 90(3,supl.1): 108-110, May-June 2015. ilus
Article in English | LILACS | ID: lil-755735



In Brazil, visceral Leishmaniasis is caused by Leishmania chagasi. The development of cutaneous lesions in visceral leishmaniasis patients has been described in two different clinical contexts. Patients with compromised immunity can develop skin lesions as a direct consequence of a current visceral disease. Equally, patients with a history of kala-azar and progressive, immune improvement occasionally develop skin lesions as a consequence of immune reconstitution infl ammatory syndrome. These cases manifest in similar fashion to the classic form of post-kala-azar dermal Leishmaniasis. We describe different cases that exemplify these two clinical presentations.


Adult , Humans , Male , AIDS-Related Opportunistic Infections/immunology , Leishmaniasis, Cutaneous/immunology , Leishmaniasis, Visceral/immunology , AIDS-Related Opportunistic Infections/drug therapy , Amphotericin B/therapeutic use , Antiprotozoal Agents/therapeutic use , Antiretroviral Therapy, Highly Active/adverse effects , HIV Infections/drug therapy , Leishmaniasis, Cutaneous/drug therapy , Leishmaniasis, Visceral/drug therapy
Rev. Soc. Bras. Med. Trop ; 48(3): 235-242, May-Jun/2015. tab, graf
Article in English | LILACS | ID: lil-749870


Leishmaniasis is one of the six major tropical diseases targeted by the World Health Organization. It is a life-threatening disease of medical, social and economic importance in endemic areas. No vaccine is yet available for human use, and chemotherapy presents several problems. Pentavalent antimonials have been the drugs of choice to treat the disease for more than six decades; however, they exhibit high toxicity and are not indicated for children, for pregnant or breastfeeding women or for chronically ill patients. Amphotericin B (AmpB) is a second-line drug, and although it has been increasingly used to treat visceral leishmaniasis (VL), its clinical use has been hampered due to its high toxicity. This review focuses on the development and in vivo usage of new delivery systems for AmpB that aim to decrease its toxicity without altering its therapeutic efficacy. These new formulations, when adjusted with regard to their production costs, may be considered new drug delivery systems that promise to improve the treatment of leishmaniasis, by reducing the side effects and the number of doses while permitting a satisfactory cost-benefit ratio.

Animals , Dogs , Humans , Amphotericin B/administration & dosage , Antiprotozoal Agents/administration & dosage , Drug Delivery Systems , Leishmaniasis, Visceral/drug therapy , Chemistry, Pharmaceutical , Nanoparticles , Nanotechnology
Rev. Inst. Med. Trop. Säo Paulo ; 57(1): 33-38, Jan-Feb/2015. tab, graf
Article in English | LILACS | ID: lil-736362


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.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Amphotericin B/therapeutic use , Antiprotozoal Agents/therapeutic use , Leishmaniasis, Visceral/drug therapy , Meglumine/therapeutic use , Organometallic Compounds/therapeutic use , Amphotericin B/adverse effects , Antiprotozoal Agents/adverse effects , Brazil , Cross-Sectional Studies , Meglumine/adverse effects , Organometallic Compounds/adverse effects , Treatment Outcome
Comun. ciênc. saúde ; 26(3/4): 145-150, 2015. tab
Article in Portuguese | LILACS | ID: biblio-996943


A leishmaniose visceral é uma doença em expansão, sobretudo em regiões urbanas. Sabe-se que em decorrência do desmatamento em áreas de floresta para a agricultura e outros fins incluindo o crescimento das cidades, o vetor da doença hoje adaptado aos grandes centros, favorece a cadeia de transmissão. A população infantil é acometida com mais frequência pela doença em questão, fato que pode ser explicado pela imaturidade imunológica. O tratamento existe e costuma ser eficaz, mas algumas vezes há recidiva da doença, sendo a terapêutica adotada e seu esquema administrado de forma completa, imperativos para a cura. Trata-se de um relato de caso no qual uma criança que foi tratada em um hospital do Sistema Único de Saúde-SUS de Brasília, Distrito Federal, apresentou recidiva de leishmaniose visceral. Foi registrada e analisada a evolução clínica da criança na primeira e segunda internação ocorridas em julho e outubro de 2014, respectivamente. O objetivo foi o de discutir os aspectos clínicos que provavelmente levaram o paciente à recidiva

Visceral leishmaniasis is a disease which is increasing, especially in urban areas. It is known that as a result of deforestation in forest areas for the growth of cities the vector of the disease has been adapting to the great centers so contributing to the chain of transmission. The pediatric population stands out in this scenario to be affected more often by the disease in question, which may be explained by the immunological immaturity. The treatment and there is usually effective, but sometimes there is recurrence of the disease, and the therapeutics adopted and its administered scheme fully, imperative for healing. This is one case report in which a child seen at a public hospital in Brasilia, Federal District, presented recurrence of visceral leishmaniasis. Was investigated the clinical course of children from the first to the second hospital admission occurred in July and October 2014, respectively, in order to discuss the clinical aspects that led the patient to relapse

Humans , Male , Child , Recurrence , Child , Leishmaniasis, Visceral , Therapeutics , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/transmission
Rio de Janeiro; s.n; 2015. xiv,190 p. ilus, graf, tab, mapas.
Thesis in Portuguese | LILACS | ID: lil-774289


A leishmaniose visceral (LV) é a forma mais severa de leishmaniose e é a segunda maior causa de mortes por doenças parasitarias depois da malária. O arsenal terapêutico contra a leishmaniose é pequeno, e cada um dos medicamentos disponíveis apresenta ao menos uma das desvantagens: toxicidade, eficácia, preço ou regime de tratamento. Nós temos concentrado esforços em estudar novos candidatos a fármacos como alternativas aos tratamentos atuais. A pterocarpanquinona LQB-118 foi desenhada e sintetizada com base em hibridação molecular e apresentou atividade em protozoários e linhagens celulares de leucemia. Resultados prévios demonstraram que a LQB-118 foi eficaz no tratamento da leishmaniose cutânea experimental e que o mecanismo de ação envolve a indução do estresse oxidativo com eventos característicos da morte celular por apoptose em Leishmania amazonensis. Neste estudo, foi observado que o tratamento com 10 mg/kg/dia por via oral de LQB- 118 inibiu o desenvolvimento de hepatoesplenomegalia em camundongos infectados com L. infantum, com uma redução de 99 por cento na carga parasitária. A análise toxicológica in vivo não apresentou nenhuma mudança nos parâmetros clínicos, bioquímicos ou hematológicos. A análise histológica evidenciou que os órgãos não apresentaram anormalidades, com a exceção do fígado, no qual foi observado focos de necrose com infiltração leucocitária com uma dose cinco vezes maior do que a dose terapêutica. Entretando, estas alterações não foram acompanhadas por aumento das transaminases. Para avaliar os eventos iniciais do mecanismo de ação da LQB- 118, promastigotas de L. amazonensis foram incubados com LQB-118 e antioxidantes. As perdas da viabilidade celular e do potencial de membrana mitocondrial não foram revertidas com os antioxidantes, embora a produção de EROs tenha sido prevenida, sugerindo que a produção de EROs não é a causa primária de morte do parasito...

Visceral leishmaniasis (VL) is the most severe form of leishmaniasis and is the second major cause of deaths byparasites after malaria. The arsenal of drugs against leishmaniasis is small, and each has a disadvantage in termsof toxicity, efficacy, price or treatment regimen. Our group has focused on studying new drug candidates asalternatives to current treatments. The pterocarpanquinone LQB-118 was designed and synthesized based onmolecular hybridization and exhibited antiprotozoal and anti-leukemic cell line activity. Our previous workdemonstrated that LQB-118 was an effective treatment of experimental cutaneous leishmaniasis and that themechanism of action involves induction of oxidative stress with characteristic events of cell death via apoptosisin Leishmania amazonensis. In this study, we observed that treatment with 10 mg/kg/day LQB-118 orallyinhibited the development of hepatosplenomegaly in L. infantum-infected mice, with a 99 percent reduction in parasiteload. The in vivo toxicological analysis showed no change in clinical, biochemical or hematological parameters.Histologically, all of the analyzed organs were normal with the exception of liver, in which focal points ofnecrosis with leukocyte infiltration were observed with a dose five times higher than the therapeutic dose.However, these changes were not accompanied by increase in transaminases. To assess the early effects of themechanism of action of LQB-118, promastigotes of L. amazonensis were incubated with LQB-118 andantioxidants. Cell viability and mitochondrial membrane potential were not reversed by the antioxidants,although the ROS production was, suggesting that ROS production is not the primary cause of parasite death...

Mice , Amphotericin B/therapeutic use , Leishmania infantum , Leishmaniasis, Visceral/drug therapy , Pterocarpans/toxicity , Acquired Immunodeficiency Syndrome , Comorbidity , Leishmaniasis/epidemiology