[Leish-l] miltefosine for diffuse leishmaniasis
Ali Khamesipour
khamesipour_ali at yahoo.com
Wed Jul 27 01:10:29 BRT 2011
Dear Sharma,
Would you please send me your articles comparing the 2 routes and the effect on larger lesions if it is in the paper. All the best Ali
Dr Ali Khamesipour
--- On Tue, 7/26/11, Sharmanl <nandlals at hotmail.com> wrote:
From: Sharmanl <nandlals at hotmail.com>
Subject: Re: [Leish-l] miltefosine for diffuse leishmaniasis
To: "Chang, Kwang-Poo" <KwangPoo.Chang at rosalindfranklin.edu>, "Carlos Costa" <chncosta at gmail.com>
Cc: "Abhay Satoskar" <Abhay.Satoskar at osumc.edu>, Mark at lineu.icb.usp.br, "Berman" <Jbe9320457 at aol.com>, dagobertosilveira at superig.com.br, "Sampaio" <rsampaio at unb.br>, "Dorcas Lamounier Costa" <dorcas.lc at gmail.com>, "Nawacki" <mnawacki at paladinlabs.com>, jurbina at mac.com, generhedin at thermosurgery.com, "Leish-L" <Leish-l at lineu.icb.usp.br>, Josh at lineu.icb.usp.br, "Pierre BUFFET" <pierre.buffet at upmc.fr>, Raimunda at lineu.icb.usp.br, "Fabiana Alves" <fabipalves at gmail.com>, Fernando at lineu.icb.usp.br, robertobadaro768 at gmail.com, "Shyam Sundarmail" <Drshyamsundar at hotmail.com>, joseanegodinho at yahoo.com.br, "Robert Vinson" <rvinson at paladinlabs.com>, "Koremblum" <fkorembl at paladinlabs.com>
Date: Tuesday, July 26, 2011, 2:57 AM
#yiv243849689 v\00003a* {}
#yiv243849689 o\00003a* {}
#yiv243849689 w\00003a* {}
#yiv243849689 .yiv243849689shape {}
#yiv243849689 st1\00003a*{}
Dear Dr. KP
This is in relation to your query on tmt. of CL with
regard to Intra-lesional vs I/M route. We have carried out one comparative
study comparing the two modes and published it. Intralesional is surely
quite effective mode but in larger lesions it sometimes result in
cobble stoning of the healing. It surely provides higher concentration of drug
at the site. However, in larger lesions it may not infiltrate evenly in the
whole lesion by this route. We combined both routes and found that the
results were slightly better than only I/L route. Combination meaning give I/L
injection and also rest of the vial inject IM as well.
I am not sure whether this answers your query or not but
I thought it may be relevant in the present context.
Thanks
NL Sharma
From: Chang, Kwang-Poo
Sent: Tuesday, July 26, 2011 12:28 AM
To: Carlos Costa
Cc: Berman ; Josh at lineu.icb.usp.br ; Mark at lineu.icb.usp.br ; jurbina at mac.com ; Pierre
BUFFET ; Fabiana Alves ; Shyam
Sundarmail ; Dorcas Lamounier Costa ; generhedin at thermosurgery.com ; Robert
Vinson ; Abhay Satoskar ; dagobertosilveira at superig.com.br
; Fernando at lineu.icb.usp.br ; Raimunda at lineu.icb.usp.br ; joseanegodinho at yahoo.com.br ; Nawacki ; Koremblum ; Sampaio ; robertobadaro768 at gmail.com ; Leish-L
Subject: Re: [Leish-l] miltefosine for diffuse
leishmaniasis
I am writing to ask for
your help with information and suggestion about treating cutaneous leishmaniasis
in
Panama .
I have only very
sketchy information about the case as follows:
An American young man has 2 skin
lesions, one of which is on the abdomen.
He was diagnosed to have cutaneous
leishmaniasis
A course of 30-day intra-muscular
injection of pentavalent antimony is prescribed.
I wonder about the
intramuscular instead of intra-lesion antimony treatment and also the duration
of the treatment for 30 days ?
Looking forward to
hearing from you at your earliest convenience.
KP
From:
Carlos Costa
[mailto:chncosta at gmail.com]
Sent: Tuesday, July 12, 2011 2:46
PM
To: Chang,
Kwang-Poo
Cc: gzischke at thermosurgery.com; Abhay
Satoskar; John David; generhedin at thermosurgery.com;
Josh Berman; dagobertosilveira at superig.com.br;
Raimunda Sampaio; Dorcas Lamounier Costa; Mark Nawacki; jurbina at mac.com; Pierre BUFFET; joseanegodinho at yahoo.com.br;
Robert Vinson; Shyam Sundarmail; robertobadaro768 at gmail.com;
Leish-L; Fernando Koremblum; Fabiana Alves; Fabiana Alves
Subject: Re: [Leish-l] miltefosine for
diffuse leishmaniasis
Hi
Gena,
Thanks a lot for
your offer.
Our purpose is to
work together with John and Abhay, who I know personally for a long time. May be
the experience here will lead to broader
application.
I am forwarding
your email to DNDi to see if they could help us in getting the machine into the
country, since they have expertise in this kind of humanitarian
treatment.
My best
regards,
Carlos.
2011/7/12 Chang, Kwang-Poo <KwangPoo.Chang at rosalindfranklin.edu>
This is good to
try.
KP
From: gzischke at thermosurgery.com [mailto:gzischke at thermosurgery.com]
Sent: Tuesday, July 12, 2011 12:47
PM
To:
Carlos Costa ; Abhay Satoskar; John David; generhedin at thermosurgery.com
Cc: Josh Berman; dagobertosilveira at superig.com.br; Raimunda Sampaio; Dorcas
Lamounier Costa; Mark Nawacki; jurbina at mac.com; Pierre BUFFET; joseanegodinho at yahoo.com.br; Robert Vinson; Shyam Sundarmail;
robertobadaro768 at gmail.com; Leish-L; Fernando Koremblum;
Chang, Kwang-Poo
Subject: RE:
[Leish-l] miltefosine for diffuse
leishmaniasis
Dear Dr.
Costas,
Thermosurgery is
committed to the research and treatment of leishmaniasis. We are pleased
to work with you and assist your patients. We can lend you an instrument
to use in your program. Our biggest hurdle is getting the equipment into
the country. If you work with an NGO or government agency that can assist
us in the importation that would be helpful.
Lets discuss the
logistics to see if it is feasible to get you the equipment. I would
suggest that you work with Dr David and Dr Satoskar on the recommended treatment
protocol.
We would want to
receive documentation regarding the use of the equipment and a paper so that we
can educate others on the value of this treatment.
Warm
regards,
gena
Gena
Zischke
Business Development
Thermosurgery Technologies, Inc.
2901
W. Indian School
Rd.
Phoenix , AZ
85017
Phone: (602)
264-7300
The information in this communication is confidential. It is
intended solely for the addressee. Access to this communication by anyone else
is unauthorized. If you are not the intended recipient, any disclosure, copying,
distribution or any action taken or omitted to be taken in reliance on it, is
prohibited and may be unlawful. If you have received this communication in
error, please notify us immediately by return email, and destroy this
communication and all copies thereof, including all attachments. Thank you.
Thermosurgery Technologies, Inc.
Fax: (602)
248-3809
-------- Original
Message --------
Subject: Re: [Leish-l] miltefosine for diffuse
leishmaniasis
From: Carlos Costa
<chncosta at gmail.com>
Date: Sun, July 10, 2011 4:23
pm
To: "Chang, Kwang-Poo" <KwangPoo.Chang at rosalindfranklin.edu>
Cc: Josh Berman
<Jbe9320457 at aol.com>, dagobertosilveira at superig.com.br,
Raimunda Sampaio <rsampaio at unb.br>, Dorcas
Lamounier Costa
<dorcas.lc at gmail.com>, Mark Nawacki <mnawacki at paladinlabs.com>,
jurbina at mac.com, Pierre BUFFET
<pierre.buffet at upmc.fr>,
joseanegodinho at yahoo.com.br, Robert Vinson <rvinson at paladinlabs.com>,
Shyam Sundarmail <Drshyamsundar at hotmail.com>,
robertobadaro768 at gmail.com, Leish-L <Leish-l at lineu.icb.usp.br>, Fernando
Koremblum <fkorembl at paladinlabs.com>
KP, do you have any idea
about prices? Please send me the brand name to see if I can easily import
them. Best wishes to Jean, Carlos
2011/7/10 Chang,
Kwang-Poo <KwangPoo.Chang at rosalindfranklin.edu>
Carlos will
undoubtedly go with those, which are clinically acceptable and feasible for
the sake of expediency.
In a separate
message, the causative agent was said to have been identified as L
amazonensis. Thermosensitivity of this species has been well-documented,
suggestive of thermotherapy. There is already the suggestion of hot bath.
One-use heat pad/heat wrap available over-the-counter in the
USA drug stores is just as
innocuous to consider as some topical ointments
suggested.
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: Saturday, July 09, 2011 10:07
AM
To: Leish-L
Cc: Josh Berman; dagobertosilveira at superig.com.br; Dorcas Lamounier Costa; jurbina at mac.com; Pierre
BUFFET; Robert Vinson; Raimunda Sampaio; Shyam Sundarmail; robertobadaro768 at gmail.com; Mark Nawacki; Fernando
Koremblum; joseanegodinho at yahoo.com.br
Subject: Re: [Leish-l]
miltefosine for diffuse leishmaniasis
Dear
friends,
This is really a
such touching and motivated community, and leish-l is proving to be an
excellent tool for solving the leishmaniasis toughest problems throughout the
world. The word "together" sounds really powerful in such a
cases.
What os showing
up from these kind emails is a face of science coming not only from the bench,
the hospitals, the field, but a science coming straight from the
heart.
Let me summarize
some of the lessons and suggestions. Please correct me if I skip
some.
1) Hot bath -
Teresina is
very hot, and hot showers are rare here. However, we can easily provide her an
electric shower. Should it be a tube? How long the bath would
last?
2) BCG - one or
two shots. We will do it. Any hint about the intervals between the
shots?
3) Previous drug
therapy: ImunoglucanTM (cell wall of Saccharomyces cerevisiae), and
saquinavir, after her delivery (Intracellular
survival of Leishmania species that cause visceral leishmaniasis is
significantly reduced by HIV-1 protease
inhibitors.).
4) Besides
miltefosine we got a good hint where to find it (
Paladino ,
Canada ), which has excellent
temporary effect (Zerpa et al, 2006), we should
consider:
a) lower/corrected
doses of paramomycin (Bryceson) - we have also to find the drug outside
Brazil , since it is not
distributed/approved here;
b)
gamma-interferon (who produces/sells
it?).
c)
fluconazol/itraconazol/(voriconazol?).
d) amiodarone -
in vitro testing does not
sounds so good.
e) topic imiquimod
(IxiumTM cream) - apparently easy to find. concentration of
5%?
f) photodynamic
therapy - with Dr. Dagoberto Silveira, we are investigating where to do it
around.
g) immunotherapy
with suicide photo-inactivated Leishmania (KP
Chang).
Please check what
really seems reasonable. My feeling is that most of the suggestions can be
tried.
My warmest
regards,
Carlos.
2011/7/8 Pierre BUFFET <pierre.buffet at upmc.fr>
Anthony,
because there are
only a few options left, would you consider at one point low dose pentamidine
(3 mg/kg every week or so, as you did in DCL patinets in
Ethiopia in
the 70s if I remember)? Could be used either to stabilize the situation before
starting on a coadministration, or as a maintenance after the
co-administration, in both cases with careful monitoring of kidney function
?
Pierre
Anthony Bryceson
<a.bryceson at doctors.org.uk> a
écrit :
Dear Carlos
As you are well aware
DCL is very difficult to treat. The big problem is that the defect in
specific CMI is more profound than that in VL and may never recover, in
contrast with the defect in VL which bounces back quickly.
To have
any chance of curing the patient, treatment should be monitored by
quantitative slit skin smears (as for splenic aspirates in VL) from multiple
pre-selected sites, every week or two weeks, and treatment continued until
negativity and for some weeks or months longer. When slit skin smears
become negative, hunt for any nodular or infiltrated lesions and take deep
biopsies and look for amastigotes there. Keep on hunting and smearing.
Sometimes, at the end of all this, evidence of CMI may appear, and cure
becomes a possibility. I am sure that the method of treating is more
important than the choice of drug - so long of course that the parasite is
susceptible to the drug.
Hannah Akuffo has sent you the abstract
relating to 3 patients treated by Sabawork Teklemariam in Addis Abeba. That
article details this approach.
Do you know the species of Leishmania
causing Maria's DCL, and its sensitivities? In Addis Abeba parasites were
cultured from two of the patients and sensitivities determined and
isobolograms drawn to look for synergy. The isolates were sensitive to
paromomycin and sodium stibogluconate was synergistic. It would be worth
while to make cultures before you start any new treatment and have the
isolate tested in this way. I expect that you have a lab that could do this;
if not, Simon Croft might be able to advise.
Miltefosine has been
very successful in a number of situations in South American CL and showed
promise for DCL, but patients relapsed despite prolonged
treatment.
1. Zerpa O, Ulrich M, Blanco B, et al. Diffuse cutaneous
leishmaniasis responds to miltefosine but then relapses. Br J Dermatol.
2007;156:1328-1335.
In a few patients with VL-HIV confection whom I
treated in
London , miltefosine worked well at first,
but the patients relpased while still on treatment and drug resistance was
supected but not tested. Miltefosine has a pharmacokinetic profile with a
long tail that might make it susceptible to the devlopment of resistance,
especially if the therapeutic window for a given isolate was narrow. So you
might want to think about adding a second drug to go with miltefosine from
the beginning. I am not sure what might be the best drug for combination;
perhaps Josh Berman might have an opinion. It is of course essential to
ensure contraception.
You could also consider the combination of
paromomycin and low dose SSG. In view of Maria's poor renal function you
might need to modify the dose of paromomycin and to monitor
function.
Robert Vinson is CEO of Paladin Labs, and would I am sure
help you locate miltefosine. <rvinson at paladin-labs.com>
Richard Chin is CEO of
One World Health, and would, I am equally sure, help you locate
paromomycin, should you consider that path. http://www.oneworldhealth.org/contact-us Phone: +1
415-421-4700 Fax: +1 415-421-4747
I wish you and Maria all the best
in this venture.
Anthony
Dear Jennie
Immunotherapy proved
rather disappointing in VL. It seems that the patient needs a decent immune
response in the first place to benefit from
immuno-boosting.
Sadly
Anthony
On 6 Jul 2011, at 20:04,
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 notify us immediately by return e-mail and
delete this message from your system.
<cleu antes grav
13jan09.jpg><cleu e nene.jpg><cleu santada
recorte.jpg><cleu panturrilhas.jpg><cleu
palato.jpg>_______________________________________________
Leish-l
mailing list
Leish-l at lineu.icb.usp.br
http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l
--
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.
_______________________________________________
Leish-l
mailing list
Leish-l at lineu.icb.usp.br
http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l
--
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.
_______________________________________________
Leish-l mailing
list
Leish-l at lineu.icb.usp.br
http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l
-----Inline Attachment Follows-----
_______________________________________________
Leish-l mailing list
Leish-l at lineu.icb.usp.br
http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://lineu.icb.usp.br/pipermail/leish-l/attachments/20110726/73961490/attachment-0001.htm>
More information about the Leish-l
mailing list