[Leish-l] miltefosine for diffuse leishmaniasis

[Carlos Costa]

Dear KP,

Confirmed by monoclonal antibodies (Edna Ishikawa) that the parasite of
Maria Cleudimar is indeed L. amazonensis.

Cheers,

Carlos.

2011/7/7 Chang, Kwang-Poo <KwangPoo.Chang at rosalindfranklin.edu>

> ** ** ** **
>
> Dear Carlos,****
>
> ** **
>
> I hope I could help out, but others outside of the ****USA**** would be
> able to do it a lot easier for miltefosine.****
>
> ** **
>
> The infection looks terrible. Are your sure it is caused by L amazonensis ?
> Send us a little DNA of this isolate. Let us take a look at it ?****
>
> ** **
>
> Should you have the isolate in culture, they could be photo-inactivated and
> used for immunotherapy. Obviously, you and Dorcas would need to prepare the
> clinical protocol and get the approval.  ****
>
> ** **
>
> KP****
>
> ** **
>  ------------------------------
>
> *From:* leish-l-bounces at lineu.icb.usp.br [mailto:
> leish-l-bounces at lineu.icb.usp.br] *On Behalf Of ***Carlos Costa
> **
> *Sent:* Wednesday, July 06, 2011 2:05 PM
> *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,
> 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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