[Leish-l] [Tropmed-l] LV patiente 92y old

[jlindoso at usp.br]

Dear colleagues,
There was a clinical trail in Brazil using miltefosina in the  
treatment of LV, however this trail had to be stopped due to poor  
response to treatment with that drug.
T treat this patient, I suggest liposomal amphotericin b in low dose  
for a longer period.
Sincerely,
José Angelo Lauletta Lindoso
Laboratório de Soroepidemiologia e Imunobiologia
Instituto de Medicina Tropical de São Paulo - USP
Av. Dr. Enéas de Carvalho Aguiar, 450, Prédio II
CEP. 05403-000
Telefone:(11) 3061 - 7023
Fax: (11) 30618270



Citando Marco Tulio Antonio Garciazapata <mctulianglobal at gmail.com>:

> ---------- Forwarded message ----------
> From: Marco Tulio Antonio Garciazapata <mctulianglobal at gmail.com>
> Date: 2012/4/17
> Subject: Re: [Tropmed-l] LV patiente 92y old
> To: Kleber Luz <klebergluz at gmail.com>
> Cc: tropmed-L at lineu.icb.usp.br
>
>
> Kleber,
>
>
>
> Through cyber and by courtesy of *Jenny F Laskarzewsky*, Pharm. D,
> BCPS (Clinical
> Pharmacist at San Ramon Regional Medical Center / San Francisco Bay Region,
> United States) have just received another information that may be of
> interest an unrandomized trial "Treatment of Bolivian mucosal leishmaniasis
> with miltefosine" (*Soto J, et al Clinical Infectious Diseases.
> 2007;44(3);350)* concluded that the cure rate for *miltefosine* (*2.5
> mg/kg/day (Max=150 mg/day) for 28 days*) was equivalent to parenteral
> Amphotericin B, with its toxicity profile is far superior to that of
> amphotericin B.
>
>
>
> *Prof. Marco Tulio A Garcia-Zapata, MD, PhD*
>
> Medical Tropicalist / Head Professor / Principal Researcher
>
> Tropical Medicine & Dermatology Department (DMTD)
>
> Center for Studies and Research in (Re)Emerging Diseases (NUPEREME)
>
> Reference Sentry for International and Travel Medicine (USCREMIVI)
>
>
>
> Caixa Postal 12911 - Setor Leste Vila Nova
>
> Goiania - GO, 74643-970, Brazil
>
> Phone(=62)3269-8219, Fax (+62)3521-1839
>
> E-mail: nupereme at gmail.com
> medicinadeviagem.hc.hdt at gmail.com
> mctulianglobal at gmail.com
>
>
> ***************
> 2012/4/15 Marco Tulio Antonio Garciazapata <mctulianglobal at gmail.com>
>
>> Kleber,
>>
>> Your case can be a "Record" in the literature. We have to offer some kind
>> of solution and quickly. Due we do not have much experience in the
>> treatment of leishmaniasis in the elderly population. Worried, I found
>> that there are few studies that deal with the issue.
>>
>>  It is well known effectiveness in the treatment of leishmaniasis, in
>> general, with the group of antimonial drugs and / or derivatives of
>> amphotericin B, but without doubt, are very toxic and not recommended in
>> these patients.
>>
>>  In the treatment of invasive fungal infections in the elderly  
>> (Aging and infectious
>> diseases, 15 August, CID 2001:33), *lipid formulations of** amphotericin B
>> * (liposome/"Ambisome", lipid complex/"Abelcet" and colloidal  
>> dispersion B/"Amphotec"
>> or "Amphocil"), would be the drugs recommended, but at high cost, are not
>> the choice. Expected in the coming years, the goianan pharmaceutical
>> industry available at the national market such formulations result of
>> promising studies in nanotechnology made ??by Faculty of Pharmacy / Federal
>> University of Goias, Brazil.
>>
>>  In this case the recommendation is to use *alternative drug*, in spite of
>> being less toxic and less effective, can be invaluable in such patients. *
>> "Primum non nocere"!!!* Draws attention to the subject with very little
>> experience using *MILTEFOSINE*, the 1st anti-leishmania drugs more
>> effective oral (Expert Review of Anti-infective Therapy, April 2006, Vol 4,
>> No. 2, Pages 177-185). But I found a review in this sense (Am. J. Trop.
>> Hyg., 78 (5), 2008, p. 745-749) and mainly a report of three cases  
>> in the"Triangulo
>> Mineiro" - MG, Brazil, of unforgettable Prof. Aluizio Prata (RIP) who
>> along with Mario Leon (Rev. Inst. Trop. S. Paulo, May-June, 200, 46 (3)
>> :175-177) successfully used, *AZITHROMYCIN* (500 mg/dia/10 days  
>> oral) in patients
>> aged 76-80 years of age.
>>
>>
>> Hopefully this information can help you.
>>
>> Best regards,
>>
>> *Prof. Marco Tulio A Garcia-Zapata, MD, PhD*
>> *Medical Tropicalist / Head Professor / Principal Researcher*
>> Tropical Medicine & Dermatology Department (DMTD)
>> Center for Studies and Research in (Re)Emerging Diseases (NUPEREME)
>> Reference Sentry Unit for International and Travel Medicine (USCREMIVI)
>> Teaching Hospital / Tropical Pathology & Public Health Institute (IPTSP)
>>
> Federal University of Goias, Brazil (UFG)
>
>>
>> Caixa Postal 12911 - Setor Leste Vila Nova
>> Goiania - GO, 74643-970, Brazil
>> Phone(=62)3269-8219, Fax (+62)3521-1839
>> E-mail: nupereme at gmail.com
>> medicinadeviagem.hc.hdt at gmail.com
>>  mctulianglobal at gmail.com
>>
>>
>>
>>
>>
>> 2012/4/9 Kleber Luz <klebergluz at gmail.com>
>>
>>> Hello every body! Today i had done a diagnose of VL in a patient 92 y
>>> old, test fast test was positive and the bone marrow aspireted was positive
>>> with a lot of leishmanias. Does anyone had a patient like this. He was HIV
>>> negative.
>>>
>>> --
>>> Prof.Adjunto III -  Kleber Giovanni Luz - DEPARTAMENTO DE
>>> INFECTOLOGIA/UFRN/HOSPITAL GISELDA TRIGUEIRO
>>> Rua Cônego Monte, 110 - QUINTAS
>>> CEP 59037-170
>>> NATAL-RN
>>> *FONE (FAX): (84) - 3215-1603
>>> FONE: (84) - 3232-7948
>>> CEL: (84) - 9193 - 6208*
>>>
>>>
>>>
>>> _______________________________________________
>>> TropMed-L mailing list
>>> TropMed-L at lineu.icb.usp.br
>>> http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/tropmed-l
>>>
>>>
>>
>
>
>
> --
> *Prof. Marco Tulio A Garcia-Zapata, MD, PhD*
> *Medical Tropicalist / Head Professor / Principal Researcher*
> Tropical Medicine & Dermatology Department (DMTD)
> Center for Studies and Research in (Re)Emerging Diseases (NUPEREME)
> Reference Sentry Unit for International and Travel Medicine (USCREMIVI)
> Tropical Pathology & Public Health Institute (IPTSP)
> Federal University of Goias (UFG)
> Goiania - GO, BRAZIL
>
> Caixa Postal 12911 - Setor Leste Vila Nova
> Goiania - GO, 74643-970, Brazil
> Phone: (+2)3269-8219, Fax (+62)3521-1839
> E-mail: nupereme at gmail.com
> medicinadeviagem.hc.hdt at gmail.com
> mctulianglobal at gmail.com
>