[Leish-l] miltefosine for diffuse leishmaniasis

Mon Jul 11 08:41:22 BRT 2011

Thanks Mourad,

As long as we start a new drug therapy we will try topic therapy wherever is
possible. Her situation is getting complicated for topical therapy since the
parasite is invading her oral and nose mucosa, and eventually could
visceralize.

Thanks for the paper. We all may be learning a lot with so many suggestions
for reading!

Kindest regards,

Carlos.

2011/7/10 mourad mokni <mourad.mokni at rns.tn>

>  *Dear Carlos,*
>
> *Topical Imiquimod is an immunomodulator agent which enhance the local
> skin interferon. It is a good treatment in Human papilloma virus warts. It
> is also used now for superficial basal cell carcinoma. In leishmaniasis it
> was tried but the result are quite disapointing because there is a relapse.
> I think it would be a good adjuvant treatment in DCL because it is an
> immunomodulator. But alone I do not think it would be miraculous.*
>
> *I think itraconazole would be worth to try even the fluconazole failed.*
>
> *I attach a review on PDT. It is a physical treatment based on tissular
> destruction by light after local application of a photosensitizer. It is now
> mainly used on multifocal superficial cancerous, precancerous and infectious
> dermatosis. *
>
> *Best regards*
>
> *Mourad MOKNI*
>
>  *On Sun, 10 Jul 2011 20:13:34 -0300, Carlos Costa wrote*
> > Dear Mourad,
> >
> > I have tried once fluconazole without result. As you saw in my last
> email, I am trying to locate some photodynamic therapy and imiquimoid aroun
> here in Brazil. But would you please clarify what is the action of
> photodynamic therapy? Have you ever used imiquimoid for leishmaniasis?
> >
> > My warmest regards,
> >
> > Carlos.
> >
> > 2011/7/8 Dr Mourad Mokni <mourad.mokni at rns.tn>
> >
>
>
>> > Dear colleague,
>> > I understand your distress the patient presentation is disturbing. I
>> agree that Miltefosine would be the best choice even that it would not
>> guarantee the absence of relapse. These patients have surely an impaired
>> immunologic response against leishmaniasis and interferon could work. But it
>> is surely more expensive than miltefosine. Did you tried fluconazole ,
>> itraconazole and topical imiquimod (which enhance IFN)? Do you have access
>> to Photodynamic therapy (PDT) ?. I hope you will have access to miltefosine
>> it is the best drug to try first.
>> > Best wishes
>> >
>> > Mourad MOKNI
>> > Professor of dermatology
>> > La Rabta Hospital
>> > Rue Jabbari Bab Saadoun 1007
>> > Tunis- Tunisia
>> >
>> > At 21:04 06/07/2011, Carlos Costa 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,
>>> reproduction and distribution. If you are not the correct recipient, please
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>>> >
>>> > Content-Type: image/jpeg; name="cleu antes grav 13jan09.jpg"
>>> > Content-Disposition: attachment; filename="cleu antes grav 13jan09.jpg"
>>>
>>> > X-Attachment-Id: f_gpslxacp0
>>> >
>>> > Content-Type: image/jpeg; name="cleu e nene.jpg"
>>> > Content-Disposition: attachment; filename="cleu e nene.jpg"
>>> > X-Attachment-Id: f_gpslxzko1
>>> >
>>> > Content-Type: image/jpeg; name="cleu santada recorte.jpg"
>>> > Content-Disposition: attachment; filename="cleu santada recorte.jpg"
>>> > X-Attachment-Id: f_gpslyf5o2
>>> >
>>> > Content-Type: image/jpeg; name="cleu panturrilhas.jpg"
>>> > Content-Disposition: attachment; filename="cleu panturrilhas.jpg"
>>> > X-Attachment-Id: f_gpslyrhu3
>>> >
>>> > Content-Type: image/jpeg; name="cleu palato.jpg"
>>> > Content-Disposition: attachment; filename="cleu palato.jpg"
>>> > X-Attachment-Id: f_gpslz0v74
>>> >
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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.
>
>
>

-- 
*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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