Dear Mourad,<div><br></div><div>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?</div>
<div><br></div><div>My warmest regards,</div><div><br></div><div>Carlos.<br><br><div class="gmail_quote">2011/7/8 Dr Mourad Mokni <span dir="ltr"><<a href="mailto:mourad.mokni@rns.tn">mourad.mokni@rns.tn</a>></span><br>
<blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex;"><br>
Dear colleague,<br>
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.<br>
Best wishes<br>
<br>
Mourad MOKNI<br>
Professor of dermatology<br>
La Rabta Hospital<br>
Rue Jabbari Bab Saadoun 1007<br>
Tunis- Tunisia<div><div></div><div class="h5"><br>
<br>
At 21:04 06/07/2011, Carlos Costa wrote:<br>
</div></div><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex"><div><div></div><div class="h5">
Dear all,<br>
<br>
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.<br>
<br>
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).<br>
<br>
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).<br>
<br>
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.<br>
<br>
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.<br>
<br>
Hoping a little from friends, my kindest regards,<br>
<br>
Carlos.<br>
<br>
PS. Please understand that the pictures are allowed not for publication or public presentation. Cleudimar permission is restricted to this forum.<br>
<br>
<br>
--<br>
Carlos H. N. Costa, MD, DSc.<br>
President<br>
Sociedade Brasileira de Medicina Tropical<br>
(Brazilian Society of Tropical Medicine)<br>
Instituto de Doenças Tropicais Natan Portella<br>
Universidade Federal do Piauí<br>
Rua Artur de Vasconcelos 151-Sul<br>
64049-750 Teresina-PI<br>
Brazil<br>
Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).<br>
<br>
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</blockquote></div><br><br clear="all"><br>-- <br><font face="verdana, sans-serif"><b>Carlos H. N. Costa, MD, DSc.</b></font><div><font face="verdana, sans-serif"><b>President</b></font></div><div><span style="font-family:verdana, sans-serif"><b>Sociedade Brasileira de Medicina Tropical </b></span></div>
<div><b><span style="font-family:verdana, sans-serif"></span></b><span style="font-family:verdana, sans-serif"><b>(Brazilian Society of Tropical Medicine)</b></span></div><div><font face="verdana, sans-serif"><b>Instituto de Doenças Tropicais Natan Portella<br>
Universidade Federal do Piauí</b></font><div><font face="verdana, sans-serif"><b>Rua Artur de Vasconcelos 151-Sul</b></font></div><div><font face="verdana, sans-serif"><b>64049-750 Teresina-PI<br>Brazil<br>Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).<br>
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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. </span></font></div>
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