[Leish-l] miltefosine for diffuse leishmaniasis

[Carlos Costa]

Hi Hannah,

Anthony's experience is a hope. We are struggling to get the drug and
aminosidine with the producers and WHO. As likely they have different
mechanisms of resistance, I am thinking if it is a good idea to use them
together in order to avoid the emergence of resistance.

Best regards,

Carlos.

2011/7/8 Hannah Akuffo <Hannah.Akuffo at sida.se>

>  Dear Carlos,****
>
> Like Jennie, I am declaring I am not a clinician. I have had a lot of
> interest in DCL in Ethiopia though.  Below find the abstract to a paper
> written by Anthony Bryceson and his colleagues of few patients with long
> standing DCL.****
>
> I can add as an anecdote, that when I met one of the patients treated with
> the combination treatment (referred to in the abstract) after more than 8
> years he had still not relapsed.****
>
> ** **
>
> I do hope someone can provide advice for treating this young woman!****
>
> Best regards****
>
> Hannah Akuffo****
>
> ** **
> Aminosidine and its combination with sodium stibogluconate in the treatment
> of diffuse cutaneous leishmaniasis caused by Leishmania aethiopica.**** Trans
> R Soc Trop Med Hyg. <http://www.ncbi.nlm.nih.gov/pubmed/7974682> 1994
> May-Jun;88(3):334-9.****
>
> Teklemariam S<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Teklemariam%20S%22%5BAuthor%5D>,
> Hiwot AG<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hiwot%20AG%22%5BAuthor%5D>,
> Frommel D<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Frommel%20D%22%5BAuthor%5D>,
> Miko TL<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Miko%20TL%22%5BAuthor%5D>,
> Ganlov G<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ganlov%20G%22%5BAuthor%5D>,
> Bryceson A<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Bryceson%20A%22%5BAuthor%5D>
> .****
>
> Armauer Hansen Research Institute (AHRI), Addis Ababa, *Ethiopia*.****
> Abstract****
>
> Treatment of *diffuse cutaneous leishmaniasis* (DCL) caused by Leishmania
> aethiopica remains unsatisfactory as the parasite is relatively insensitive
> to antimonial compounds. Reports of the clinical effectiveness of
> aminosidine sulphate, especially in combination with sodium stibogluconate,
> in visceral *leishmaniasis* and the finding that this antibiotic is potent
> against L. aethiopica in vitro, prompted us to evaluate its usefulness in
> DCL. Two patients with long-standing, active DCL were treated for 60 d with
> aminosidine sulphate, 14 mg/kg/d parenterally. The skin lesions resolved
> completely in both patients although they relapsed subsequently. Synergism
> between aminosidine and stibogluconate was demonstrated in vitro against
> parasites isolated from the patients. This led us to administer combined
> therapy, aminosidine sulphate 14 mg/kg/d and sodium stibogluconate 10
> mg/kg/d, to the 2 patients in relapse and to another, third patient.
> Treatment was continued for 2 months beyond parasitological cure. Side
> effects were minimal. Following treatment, a return of specific
> cell-mediated immunity occurred, as expressed by a moderate infiltration of
> lymphocytes into the lesions and by lymphocyte proliferation in vitro in the
> presence of live Leishmania antigen, with synthesis of interleukin-2 and
> interferon gamma with one patient and interleukin 4 with the other. During
> follow-up periods of 2 to 21 months after treatment, no sign of relapse was
> seen.****
>
> ** **
>
> ** **
>
> *From:* leish-l-bounces at lineu.icb.usp.br [mailto:
> leish-l-bounces at lineu.icb.usp.br] *On Behalf Of *Carlos Costa
> *Sent:* den 6 juli 2011 21:05
>
> *To:* Leish-L
> *Subject:* [Leish-l] miltefosine for diffuse leishmaniasis****
>
> ** **
>
> 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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> notify us immediately by return e-mail and delete this message from your
> system. ****
>
> ** **
>



-- 
*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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