[Tropmed-l] LV patiente 92y old

Thu Apr 19 20:08:35 BRT 2012

Dear all: I agree with Dr Marco Tulio (Hello Professor !) with the importance of the recognition of this alternative (or soon the first option ???) Miltefosine, but it can´t be available in many countries. Then the importance to remember both, Ampho lipid formulations or Miltefosine like the best options for this patient

Best regards

Dr. Tomás A. Orduna
Jefe de Servicio
Patologías Regionales y Medicina Tropical (CEMPRA-MT)
Hospital de Infecciosas F. J. Muñiz
Uspallata 2272 (C.P. 1282)
Buenos Aires - Argentina
T.E.:(54-11) 4305-3161
T.E.:Conmutador:(+54-11) 4305-0357/1944(int.231)
Fax: (+54-11) 4304-2386
torduna at intramed.net<mailto:torduna at intramed.net>

________________________________
De: tropmed-l-bounces at lineu.icb.usp.br [tropmed-l-bounces at lineu.icb.usp.br] en nombre de Marco Tulio Antonio Garciazapata [mctulianglobal at gmail.com]
Enviado el: martes, 17 de abril de 2012 17:29
Para: Kleber Luz
CC: tropmed-L at lineu.icb.usp.br
Asunto: Re: [Tropmed-l] LV patiente 92y old

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 at gmail.com<mailto:nupereme at gmail.com>
medicinadeviagem.hc.hdt at gmail.com<mailto:medicinadeviagem.hc.hdt at gmail.com>
mctulianglobal at gmail.com<mailto:mctulianglobal at gmail.com>

***************

2012/4/15 Marco Tulio Antonio Garciazapata <mctulianglobal at gmail.com<mailto:mctulianglobal at 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<tel:62%293269-8219>, Fax (+62)3521-1839<tel:%28%2B62%293521-1839>
E-mail: nupereme at gmail.com<mailto:nupereme at gmail.com>
medicinadeviagem.hc.hdt at gmail.com<mailto:medicinadeviagem.hc.hdt at gmail.com>
 mctulianglobal at gmail.com<mailto:mctulianglobal at gmail.com>

2012/4/9 Kleber Luz <klebergluz at gmail.com<mailto:klebergluz at 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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