[Tropmed-l] LV patiente 92y old

Sat Apr 21 08:35:46 BRT 2012

Who knows what is the present legal situation of miltefosine in Brazil?

2012/4/17 Marco Tulio Antonio Garciazapata <mctulianglobal em gmail.com>

> 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 em gmail.com
> medicinadeviagem.hc.hdt em gmail.com
> mctulianglobal em gmail.com
>
>
> ***************
> 2012/4/15 Marco Tulio Antonio Garciazapata <mctulianglobal em 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 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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>>>
>>
>
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-- 
Carlos H. N. Costa, MD, DSc.
Sociedade Brasileira de Medicina Tropical
(Brazilian Society of Tropical Medicine)
President

Universidade Federal do Piauí
Instituto de Doenças Tropicais Natan Portella
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Brazil
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