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1.
Clin Infect Dis ; 77(4): 574-582, 2023 08 22.
Article in English | MEDLINE | ID: mdl-37100061

ABSTRACT

BACKGROUND: Meglumine antimoniate (MA) remains the main treatment for cutaneous leishmaniasis (CL). Uncontrolled studies suggest that intralesional MA (IL-MA) may be noninferior and safer than systemic MA (S-MA). METHODS: Multicenter, randomized, controlled, open-label, phase 3 clinical trial to evaluate the efficacy and toxicity of IL-MA in 3 infiltrations at 14-day intervals compared with S-MA (10-20 mg Sb5+/kg/day, 20 days) for CL, with noninferiority margin of 20%. Primary and secondary outcomes were definitive cure at day 180 and epithelialization rate at day 90 of treatment, respectively. A 2-year follow-up was performed to assess relapses and emergence of mucosal lesions. Adverse events (AEs) were monitored according to the Division of AIDS AE grading system. RESULTS: We evaluated 135 patients. The cure rates (95% confidence interval) for IL-MA and S-MA treatment were, respectively, 82.8% (70.5-91.4) and 67.8% (53.3-78.3) per protocol (PP) and 70.6% (58.3-81.0) and 59.7% (47.0-71.5) per intention to treat (ITT). The epithelialization rates of the IL-MA and S-MA treatment were, respectively, 79.3% (66.6-88 + 8) and 71.2% (57.9-82.2) PP and 69.1% (55.2-78.5) and 64.2% (50.0-74.2) ITT. AEs in the IL-MA and S-MA groups were, respectively, clinical, 45.6% and 80.6%; laboratory, 26.5% and 73.1%; and electrocardiogram, 8.8% and 25.4%. Ten participants in the S-MA group and 1 in the IL-MA group were discontinued due to severe or persistent AEs. CONCLUSIONS: IL-MA provides a similar cure rate and results in less toxicity compared with S-MA and may be used as first-line therapy for CL patients. CLINICAL TRIALS REGISTRATION: REBEC: RBR-6mk5n4.


Subject(s)
Antiprotozoal Agents , Leishmaniasis, Cutaneous , Organometallic Compounds , Humans , Meglumine Antimoniate/therapeutic use , Meglumine Antimoniate/adverse effects , Antiprotozoal Agents/adverse effects , Meglumine/adverse effects , Brazil , Treatment Outcome , Organometallic Compounds/adverse effects , Leishmaniasis, Cutaneous/drug therapy
2.
Diagn Microbiol Infect Dis ; 79(4): 413-8, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24923211

ABSTRACT

The aim of this study was to evaluate the effectiveness of polymerase chain reaction (PCR) using Kinetoplastid DNA (kDNA) from nasal swabs (NSs), saliva, and oral filter paper imprints (OFPI) in diagnosing mucocutaneous leishmaniasis (ML) and cutaneous leishmaniasis (CL). Seventeen patients with ML, 19 patients with CL, and 33 controls were evaluated. In patients with ML, PCR from NS showed an 86% diagnostic accuracy (95% confidence interval [CI] = 73.81-93.05), followed by saliva 74% (95% CI = 60.45-84.13) and OFPI 68% (95% CI = 54.19-79.24). The highest sensitivity was reached by using the NS 58.82% (95% CI = 36.01-78.39), followed by saliva 23.53% (95% CI = 9.56-47.26) and OFPI 5.88% (95% CI = 1.05-26.98). The specificities of the tests were complete. The NS and OFPI were positive in 2 cases of CL. Mucous membrane samples exhibited a higher specificity compared to the Montenegro skin test and indirect immunofluorescence. NS sensitivity was higher than that of parasitological examinations.


Subject(s)
Leishmania/genetics , Leishmaniasis, Mucocutaneous/diagnosis , Leishmaniasis, Mucocutaneous/parasitology , Adult , Aged , Aged, 80 and over , Case-Control Studies , DNA, Kinetoplast , Female , Humans , Leishmania/classification , Leishmania/isolation & purification , Male , Middle Aged , Polymerase Chain Reaction/methods , Reproducibility of Results , Sensitivity and Specificity
3.
Biochem Biophys Res Commun ; 347(3): 739-46, 2006 Sep 01.
Article in English | MEDLINE | ID: mdl-16844081

ABSTRACT

Six new antimicrobial peptides structurally related to the dermaseptin family have been isolated from the skin secretion of the amphibian Phyllomedusa hypochondrialis. The primary structures of these molecules named as DShypo 01, 02, 03, 04, 06, and 07 were determined by de novo MS/MS experiments, Edman degradation, and cDNA sequencing. The fifth peptide was found to be precisely the same DS 01 from Phyllomedusa oreades previously described by our group. The majority of the peptides purified from the crude skin secretion could be directly localized and mapped onto a freshly dissected dorsal skin fragment using mass spectrometry-imaging techniques. Comparisons between peptides and commercial drugs on their antibacterial and anti-Leishmania amazonensis efficiencies, associated with peptide lytic effects on mammalian blood cells and surface plasmon resonance interaction studies on immobilized DMPC vesicles, were also performed.


Subject(s)
Amphibian Proteins/metabolism , Antimicrobial Cationic Peptides/metabolism , Anura/metabolism , Amino Acid Sequence , Amphibian Proteins/chemistry , Amphibian Proteins/isolation & purification , Amphibian Proteins/pharmacology , Animals , Anti-Bacterial Agents/chemistry , Anti-Bacterial Agents/isolation & purification , Anti-Bacterial Agents/metabolism , Anti-Bacterial Agents/pharmacology , Antimicrobial Cationic Peptides/chemistry , Antimicrobial Cationic Peptides/isolation & purification , Antimicrobial Cationic Peptides/pharmacology , Humans , Leishmania/drug effects , Leukocytes/drug effects , Molecular Sequence Data , Peptide Fragments/chemistry , Peptide Fragments/isolation & purification , Peptide Fragments/metabolism , Peptide Fragments/pharmacology , Pseudomonas aeruginosa/drug effects , Sequence Alignment , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Staphylococcus aureus/drug effects , Surface Plasmon Resonance
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