[Leish-l] miltefosine for diffuse leishmaniasis

[Carlos Costa]

Hi Jennie,

Thanks for the drug information. Now, I have to check the permission for its
use in Brazil and how to justify its use to the public system in order to be
acquired by the government. Meanwhile, we are looking for miltefosine,
paramomycin, and alternative therapies.

But if the immunosuppression is species specific do you think that a general
stimulation would reverse it? Does anyone knows which is the mechanism
behind the DCL induced immunosuppression? Parasite or host or both?

Cheers,

Carlos.

2011/7/7 Jennie Blackwell <jmb37 at cam.ac.uk>

> 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 she 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).
> *
> Aviso: As informações contidas nesta mensagem são CONFIDENCIAIS, protegidas
> pelo sigilo legal, por direitos autorais e destinadas exclusivamente à
> pessoa ou organização para a qual a mensagem foi destinada.
> Warning: This message is meant only for the intended recipient of the
> transmission.  It is forbidden any unauthorized use, alteration,
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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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-- 
*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).
*
Aviso: As informações contidas nesta mensagem são CONFIDENCIAIS, protegidas
pelo sigilo legal, por direitos autorais e destinadas exclusivamente à
pessoa ou organização para a qual a mensagem foi destinada.
Warning: This message is meant only for the intended recipient of the
transmission.  It is forbidden any unauthorized use, alteration,
reproduction and distribution. If you are not the correct recipient, please
notify us immediately by return e-mail and delete this message from your
system.
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