[Tropmed-l] LV patiente 92y old

Sun Apr 15 09:27:42 BRT 2012

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 *METILFOSINE*, 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 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 em gmail.com
medicinadeviagem.hc.hdt em gmail.com
 mctulianglobal em gmail.com

2012/4/9 Kleber Luz <klebergluz em 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*
>
>
>
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