RESUMEN
Cutaneous leishmaniasis (CL) is not a life-threatening condition. However, its treatment can cause serious adverse effects and may sometimes lead to death. Recently, safer local treatments have been included among therapies acceptable to New World CL cases, but the use of intralesional meglumine antimoniate (IL-MA) is recommended to be performed in reference centers, for patients with single cutaneous lesions <3 cm in diameter at any location except the head and periarticular regions; the volume of injected MA should not exceed 5 mL. In this study we compared two groups of patients with CL treated with MA in a primary health care unit in Brazil. Patients were treated with systemic MA (n = 76) or IL-MA (n = 30). In the IL-MA group, 93% of patients had one or more of the following lesion characteristics: two or more lesions, lesions >3 cm in diameter, lesions located in the head or in periarticular regions, or had been administered IL-MA volumes >5 mL. Patients responded well (68.4% and 66.7% for the MA and IL-MA groups, respectively). When a second cycle of treatment was necessary, the responses were 72.4% and 90%, respectively. There were no significant differences between groups. In the IL-MA group, 43% had mild to moderate adverse effects, without needing treatment discontinuation. Results suggest that the treatment of CL lesions with IL-MA is simple, efficient, and safe.
Asunto(s)
Antiprotozoarios/administración & dosificación , Leishmaniasis Cutánea/tratamiento farmacológico , Antimoniato de Meglumina/administración & dosificación , Atención Primaria de Salud , Adolescente , Adulto , Instituciones de Atención Ambulatoria , Antiprotozoarios/efectos adversos , Brasil , Femenino , Humanos , Inyecciones Intralesiones , Inyecciones Intramusculares , Inyecciones Intravenosas , Masculino , Antimoniato de Meglumina/efectos adversos , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenAsunto(s)
Antiprotozoarios/administración & dosificación , Leishmaniasis Cutánea/tratamiento farmacológico , Meglumina/administración & dosificación , Compuestos Organometálicos/administración & dosificación , Factores de Edad , Anciano , Anciano de 80 o más Años , Antiprotozoarios/efectos adversos , Brasil , Esquema de Medicación , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Femenino , Humanos , Masculino , Meglumina/efectos adversos , Antimoniato de Meglumina , Persona de Mediana Edad , Compuestos Organometálicos/efectos adversosRESUMEN
We studied 52 patients with sporotrichosis confirmed by isolation of Sporothrix schenckii and reactivity to the Montenegro skin test (MST) during an ongoing outbreak of this mycosis in Rio de Janeiro. The objective was to emphasize the importance of parasitological confirmation and the possibility of incorrect diagnosis based on the lesion's appearance, epidemiological information, and immunological tests. The antigen used for the MST was conserved in either thimerosal 1:10,000 (group 1) or 0.4% phenol (group 2). Nineteen patients (39%) in group 1 and seven (12%) in group 2 presented an induration>or=10 mm (p<0.001). Sera from three patients (6.7%) reacted to indirect immunofluorescence (IIF) for leishmaniasis, while sera from 10 patients (22.2%) reacted to enzyme-linked immunosorbent assay (ELISA). Fifteen patients (28.8%) presented up to two lesions, with a predominance of ulcers. Forty-four patients (84.6%) were treated with itraconazole. In the differential diagnosis between sporotrichosis and cutaneous leishmaniasis, the possibility of co-infection, allergy to the reagent diluent, and cross-reactions should be further investigated, especially in regions with limited laboratory facilities.