[Leish-l] miltefosine for diffuse leishmaniasis

[Jennie Blackwell]

Hello Carlos

My memory from late 80s was that these patients responded well to  
interferon-gamma treatment. With all the moves to make drugs more  
affordable for disease endemic countries, has it not been possible to  
consider this option?

In psoriasis they use creams with Vitamin D. Has anyone ever tried  
this for DCL?

I'm sure this is going to elicit a round of responses - but you know  
I'm not a clinician so I would just be interested to know!

Cheers, Jennie

Jenefer M. Blackwell
TICHR, CCHR, UWA
Phone: +61 8 94897910
 From my iPhone

On 07/07/2011, at 3:04, Carlos Costa <chncosta at gmail.com> wrote:

> Dear all,
>
> Maria Cleudimar has cutaneous diffuse leishmaniasis due to  
> Leishmania amazonensis. She used to be a long time patient form Dr.  
> Jackson Costa, in the countryside of Maranhão State, Brazil, since s 
> he was 10 years old, after a disease that started when she was just  
> five. Now, she is under my and Dorcas care, at the age of 30, living 
>  in the city of Teresina.
>
> Her long time DCL does not respond to the treatment antimonium  
> anymore. Although we still prescribe liposomal amphotericin B at  
> very low dose (3mg/kg/once a week), her situation is deteriorating  
> progressively, her renal function does not allow any additional  
> dosing since creatinine is presently above 3mg/dL, and previous  
> biopsy had shown tubular damage apparently secondary to the drug,  
> without evidence of amyloidosis. We tried several combinations of  
> different drugs, without success. Her situation worsened a lot  
> during her recent pregnancy (the baby is eight months old now).
>
> Our hope now stands only in miltefosine, for oral chronic use, but  
> the drug is not licensed or available in Brazil yet (to my knowledge).
>
> With her permission I attached some of her pictures, hoping to  
> sensitize critical people in order to help me to get miltefosine and  
> the permission for prescription in Brazil (or any other oral drug  
> with promising efficacy, and without nephrotoxicity, if known).  
> Moreover, we need to know about the dose adjustment for the renal  
> impairment, and how long the drug could safely be used.
>
> One picture shows her face before treatment, and another after the  
> pregnancy, with the baby. One shows the situation of her thighs,  
> another the calf of the leg and the last one the infiltration of the  
> palate.
>
> Hoping a little from friends, my kindest regards,
>
> Carlos.
>
> PS. Please understand that the pictures are allowed not for  
> publication or public presentation. Cleudimar permission is  
> restricted to this forum.
>
>
> -- 
> Carlos H. N. Costa, MD, DSc.
> President
> Sociedade Brasileira de Medicina Tropical
> (Brazilian Society of Tropical Medicine)
> Instituto de Doenças Tropicais Natan Portella
> Universidade Federal do Piauí
> Rua Artur de Vasconcelos 151-Sul
> 64049-750 Teresina-PI
> Brazil
> Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).
>
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>
> <cleu antes grav 13jan09.jpg>
> <cleu e nene.jpg>
> <cleu santada recorte.jpg>
> <cleu panturrilhas.jpg>
> <cleu palato.jpg>
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