Hi Hannah,<div><br></div><div>Anthony's experience is a hope. We are struggling to get the drug and aminosidine with the producers and WHO. As likely they have different mechanisms of resistance, I am thinking if it is a good idea to use them together in order to avoid the emergence of resistance.</div>
<div><br></div><div>Best regards,</div><div><br></div><div>Carlos.<br><br><div class="gmail_quote">2011/7/8 Hannah Akuffo <span dir="ltr"><<a href="mailto:Hannah.Akuffo@sida.se">Hannah.Akuffo@sida.se</a>></span><br>
<blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex;">
<div lang="EN-GB" link="blue" vlink="purple">
<div>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D">Dear Carlos,<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D">Like Jennie, I am declaring I am not a clinician. I have had a lot of interest in DCL in Ethiopia though. Below find the abstract to a paper written by Anthony
Bryceson and his colleagues of few patients with long standing DCL.<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D">I can add as an anecdote, that when I met one of the patients treated with the combination treatment (referred to in the abstract) after more than 8 years he
had still not relapsed.<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D">I do hope someone can provide advice for treating this young woman!<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D">Best regards<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D">Hannah Akuffo<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D"><u></u> <u></u></span></p>
<h1 style="background:white"><span style="font-size:13.5pt">Aminosidine and its combination with sodium stibogluconate in the treatment of diffuse cutaneous leishmaniasis caused by Leishmania aethiopica.<u></u><u></u></span></h1>
<h1 style="background:white"><span style="font-size:9.0pt"><a href="http://www.ncbi.nlm.nih.gov/pubmed/7974682" title="Transactions of the Royal Society of Tropical Medicine and Hygiene." target="_blank"><span lang="SV">Trans R Soc Trop Med
Hyg.</span></a></span><span style="font-size:9.0pt">
</span><span style="font-size:9.0pt">1994 May-Jun;88(3):334-9.</span><span style="font-size:13.5pt"><u></u><u></u></span></h1>
<p class="MsoNormal" style="line-height:21.6pt;background:white"><span style="font-size:9.0pt"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Teklemariam%20S%22%5BAuthor%5D" target="_blank">Teklemariam S</a>,
<a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hiwot%20AG%22%5BAuthor%5D" target="_blank">Hiwot AG</a>,
<a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Frommel%20D%22%5BAuthor%5D" target="_blank">Frommel D</a>,
<a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Miko%20TL%22%5BAuthor%5D" target="_blank">Miko TL</a>,
<a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ganlov%20G%22%5BAuthor%5D" target="_blank">Ganlov G</a>,
<a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Bryceson%20A%22%5BAuthor%5D" target="_blank">
Bryceson A</a>.<u></u><u></u></span></p>
<p style="line-height:21.6pt;background:white"><span style="font-size:9.0pt">Armauer Hansen Research Institute (AHRI), Addis Ababa,
<b>Ethiopia</b>.<u></u><u></u></span></p>
<h3 style="line-height:21.6pt;background:white"><span style="font-size:12.5pt">Abstract<u></u><u></u></span></h3>
<p style="line-height:21.6pt;background:white"><span style="font-size:9.0pt">Treatment of
<b>diffuse cutaneous leishmaniasis</b> (DCL) caused by Leishmania aethiopica remains unsatisfactory as the parasite is relatively insensitive to antimonial compounds. Reports of the clinical effectiveness of aminosidine sulphate, especially in combination with
sodium stibogluconate, in visceral <b>leishmaniasis</b> and the finding that this antibiotic is potent against L. aethiopica in vitro, prompted us to evaluate its usefulness in DCL. Two patients with long-standing, active DCL were treated for 60 d with aminosidine
sulphate, 14 mg/kg/d parenterally. The skin lesions resolved completely in both patients although they relapsed subsequently. Synergism between aminosidine and stibogluconate was demonstrated in vitro against parasites isolated from the patients. This led
us to administer combined therapy, aminosidine sulphate 14 mg/kg/d and sodium stibogluconate 10 mg/kg/d, to the 2 patients in relapse and to another, third patient. Treatment was continued for 2 months beyond parasitological cure. Side effects were minimal.
Following treatment, a return of specific cell-mediated immunity occurred, as expressed by a moderate infiltration of lymphocytes into the lesions and by lymphocyte proliferation in vitro in the presence of live Leishmania antigen, with synthesis of interleukin-2
and interferon gamma with one patient and interleukin 4 with the other. During follow-up periods of 2 to 21 months after treatment, no sign of relapse was seen.<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D"><u></u> <u></u></span></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:10.0pt">From:</span></b><span lang="EN-US" style="font-size:10.0pt"> <a href="mailto:leish-l-bounces@lineu.icb.usp.br" target="_blank">leish-l-bounces@lineu.icb.usp.br</a> [mailto:<a href="mailto:leish-l-bounces@lineu.icb.usp.br" target="_blank">leish-l-bounces@lineu.icb.usp.br</a>]
<b>On Behalf Of </b>Carlos Costa<br>
<b>Sent:</b> den 6 juli 2011 21:05</span></p><div class="im"><br>
<b>To:</b> Leish-L<br>
<b>Subject:</b> [Leish-l] miltefosine for diffuse leishmaniasis<u></u><u></u></div><p></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal"><span style="font-size:13.5pt;color:black">Dear all,</span><u></u><u></u></p><div><div></div><div class="h5">
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:13.5pt;color:black">Maria Cleudimar has cutaneous diffuse leishmaniasis due to
<i>Leishmania amazonensis</i>. 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.</span><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:13.5pt;color:black">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).</span><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:13.5pt;color:black">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).</span><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:13.5pt;color:black">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.</span><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:13.5pt;color:black">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.</span><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:13.5pt;color:black">Hoping a little from friends, my kindest regards,</span><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:13.5pt;color:black">Carlos.</span><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:13.5pt;color:black">PS. Please understand that the pictures are allowed not for publication or public presentation. Cleudimar permission is restricted to this forum.</span><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal"><br>
-- <br>
<b><span>Carlos H. N. Costa, MD, DSc.</span></b><u></u><u></u></p>
<div>
<p class="MsoNormal"><b><span>President</span></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><span>Sociedade Brasileira de Medicina Tropical </span></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><span>(Brazilian Society of Tropical Medicine)</span></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><span>Instituto de Doenças Tropicais Natan Portella<br>
Universidade Federal do Piauí</span></b><u></u><u></u></p>
<div>
<p class="MsoNormal"><b><span>Rua Artur de Vasconcelos 151-Sul</span></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><span>64049-750 Teresina-PI<br>
Brazil<br>
Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).<br>
</span></b><span><br>
</span><span style="font-size:10.0pt">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.<br>
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><u></u><u></u></p>
</div>
</div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
</div></div></div>
</div>
</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>
</b><br><span style="font-size:x-small">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.<br>
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>
</div><br>
</div>