<font color="#000000"><font size="4"><font face="verdana,sans-serif">Dear KP,</font></font></font><div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br></font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">Confirmed by monoclonal antibodies (Edna Ishikawa) that the parasite of Maria Cleudimar is indeed L. amazonensis.</font></font></font></div>
<div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br></font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">Cheers,</font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br>
</font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">Carlos.<br></font></font></font><br><div class="gmail_quote">2011/7/7 Chang, Kwang-Poo <span dir="ltr"><<a href="mailto:KwangPoo.Chang@rosalindfranklin.edu">KwangPoo.Chang@rosalindfranklin.edu</a>></span><br>
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<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">Dear Carlos,<u></u><u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"><u></u> <u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">I hope I could help out, but others
outside of the <u></u><u></u>USA<u></u><u></u>
would be able to do it a lot easier for miltefosine.<u></u><u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"><u></u> <u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">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 ?<u></u><u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"><u></u> <u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">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. <u></u><u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"><u></u> <u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">KP<u></u><u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><b><font size="2" face="Tahoma"><span style="font-size:10.0pt;font-family:Tahoma;font-weight:bold">From:</span></font></b><font size="2" face="Tahoma"><span style="font-size:10.0pt;font-family:Tahoma">
<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><span style="font-weight:bold">On Behalf Of </span></b><u></u>Carlos
Costa</span></font></p><font size="2" face="Tahoma"><div class="im"><u></u><br>
<b><span style="font-weight:bold">Sent:</span></b> Wednesday, July 06, 2011
2:05 PM<br>
<b><span style="font-weight:bold">To:</span></b> Leish-L<br>
</div><b><span style="font-weight:bold">Subject:</span></b> [Leish-l] miltefosine for
diffuse leishmaniasis</font><u></u><u></u><p></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
<p class="MsoNormal"><font size="4" color="black" face="Verdana"><span style="font-size:13.5pt;font-family:Verdana;color:black">Dear all,</span></font><u></u><u></u></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><font size="4" color="black" face="Verdana"><span style="font-size:13.5pt;font-family:Verdana;color:black">Maria Cleudimar has
cutaneous diffuse leishmaniasis due to <i><span style="font-style:italic">Leishmania
amazonensis</span></i>. She used to be a long time patient form Dr. Jackson
Costa, in the countryside of <u></u><u></u>Maranhão
State<u></u>, <u></u>Brazil<u></u><u></u>,
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 <u></u><u></u>Teresina<u></u><u></u>.</span></font><u></u><u></u></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><font size="4" color="black" face="Verdana"><span style="font-size:13.5pt;font-family:Verdana;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></font><u></u><u></u></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><font size="4" color="black" face="Verdana"><span style="font-size:13.5pt;font-family:Verdana;color:black">Our hope now stands
only in miltefosine, for oral chronic use, but the drug is not licensed or
available in <u></u><u></u>Brazil<u></u><u></u>
yet (to my knowledge).</span></font><u></u><u></u></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><font size="4" color="black" face="Verdana"><span style="font-size:13.5pt;font-family:Verdana;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 <u></u><u></u>Brazil<u></u><u></u> (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></font><u></u><u></u></p>
</div>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><font size="4" color="black" face="Verdana"><span style="font-size:13.5pt;font-family:Verdana;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></font><u></u><u></u></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><font size="4" color="black" face="Verdana"><span style="font-size:13.5pt;font-family:Verdana;color:black">Hoping a little from
friends, my kindest regards,</span></font><u></u><u></u></p>
</div>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><font size="4" color="black" face="Verdana"><span style="font-size:13.5pt;font-family:Verdana;color:black">Carlos.</span></font><u></u><u></u></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><font size="4" color="black" face="Verdana"><span style="font-size:13.5pt;font-family:Verdana;color:black">PS. Please understand
that the pictures are allowed not for publication or public presentation.
Cleudimar permission is restricted to this forum.</span></font><u></u><u></u></p>
</div>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><br>
-- <br>
</span></font><b><font face="Verdana"><span style="font-family:Verdana;font-weight:bold">Carlos H. N. Costa, MD, DSc.</span></font></b><u></u><u></u></p>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">President</span></font></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">Sociedade Brasileira de Medicina
Tropical </span></font></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">(Brazilian Society of Tropical Medicine)</span></font></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">Instituto de Doenças Tropicais Natan
Portella<br>
Universidade Federal do Piauí</span></font></b><u></u><u></u></p>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">Rua Artur de Vasconcelos 151-Sul</span></font></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">64049-750 Teresina-PI<br>
<u></u><u></u>Brazil<u></u><u></u><br>
Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).<br>
</span></font></b><font face="Verdana"><span style="font-family:Verdana"><br>
</span></font><font size="2" face="Verdana"><span style="font-size:10.0pt;font-family:Verdana">Aviso: As informações contidas nesta mensagem são
CONFIDENCIAIS, protegidas pelo sigilo legal, por direitos autorais e destinadas
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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
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</div>
<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></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>
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