<div>Kleber,</div><div> </div><div><span class="hps">Your case</span> <span class="hps">can be</span> <span class="hps">a</span> <span class="hps atn">"</span><span>Record"</span> <span class="hps">in the literature.</span> W<span class="hps">e have to</span> <span class="hps">offer some kind of</span> <span class="hps">solution and</span> <span class="hps">quickly.</span> Due<span class="hps"> we do not</span> <span class="hps">have much experience</span> <span class="hps">in the treatment</span> <span class="hps">of leishmaniasis</span> <span class="hps">in the elderly population</span><span>.</span> <span class="hps">Worried</span><span>, I</span><span class="hps"> found that</span> <span class="hps">there are</span> <span class="hps">few studies</span> <span class="hps">that deal with</span> <span class="hps">the issue</span><span>.</span></div>
<span></span><div><br> <span class="hps">It is well</span> <span class="hps">known</span> <span class="hps">effectiveness</span> <span class="hps">in the treatment</span> <span class="hps">of leishmaniasis</span><span>,</span> <span class="hps">in general, with</span> <span class="hps">the group of</span> <span class="hps">antimonial</span> <span class="hps">drugs</span> <span class="hps">and /</span> <span class="hps">or</span> <span class="hps">derivatives</span> <span class="hps">of amphotericin B</span><span>,</span> <span class="hps">but without</span> <span class="hps">doubt,</span> <span class="hps">are very</span> <span class="hps">toxic and</span> <span class="hps">not recommended</span> <span class="hps">in these patients</span><span>.</span></div>
<span></span><div><br> <span class="hps">In the treatment of</span> <span class="hps">invasive fungal infections</span> <span class="hps">in the elderly</span> <font size="1"><span class="hps atn">(</span><span>Aging and</span> <span class="hps">infectious diseases</span><span>, 15 August, CID</span> <span class="hps">2001:33</span><span>)</span></font><span><font size="1">,</font> <strong>lipid formulations of</strong></span><strong> <span class="hps">amphotericin</span> <span class="hps">B</span></strong> <font size="1"><span class="hps atn">(</span><span>liposome/"Ambisome"</span><span>,</span> <span class="hps">lipid complex/"Abelcet" and</span> <span class="hps">colloidal dispersion</span> <span class="hps">B/"Amphotec" or "Amphocil"</span><span>)</span><span>,</span></font> <span class="hps">would be</span> the drugs <span class="hps">recommended</span><span>,</span> <span class="hps">but at</span> <span class="hps">high cost</span><span>,</span> <span class="hps">are not</span> <span class="hps">the</span> <span class="hps">choice</span><span>.</span> E<span class="hps">xpected</span> <span class="hps">in the coming</span> <span class="hps">years, the</span> goianan <span class="hps">pharmaceutical industry</span> <span class="hps">available at the</span> national<span class="hps"> market</span> <span class="hps">such</span> <span class="hps">formulations</span> <span class="hps">result of</span> <span class="hps">promising</span> <span class="hps">studies</span> <span class="hps">in nanotechnology</span> <span class="hps">made by</span> <span class="hps">Faculty of Pharmacy /</span> <span class="hps">Federal University of Goias, Brazil</span><span>.</span></div>
<span></span><div><br> <span class="hps">In this case</span> <span class="hps">the recommendation</span> <span class="hps">is to use</span> <span class="hps"><strong><font size="4">alternative drug</font></strong></span><span>, in spite</span> <span class="hps">of being</span> <span class="hps">less toxic and</span> <span class="hps">less effective,</span> <span class="hps">can be</span> <span class="hps">invaluable</span> <span class="hps">in such</span> <span class="hps">patients.</span> <font color="#3333ff"><strong><span class="hps atn">"</span><span>Primum non</span> <span class="hps">nocere"!!!</span></strong></font> <span class="hps">Draws</span> <span class="hps">attention to</span> <span class="hps">the</span> <span class="hps">subject with</span> <span class="hps">very little experience</span> <span class="hps">using</span> <span class="hps"><strong><font size="4">METILFOSINE</font></strong></span><span>, the 1st</span> <span class="hps">anti</span><span class="atn">-</span><span>leishmania</span> <span class="hps">drugs</span> <span class="hps">more effective</span> <span class="hps">oral</span> <font size="1"><span class="hps">(Expert</span> <span class="hps">Review of</span> <span class="hps">Anti</span><span class="atn">-</span><span>infective</span> <span class="hps">Therapy</span><span>, April</span> <span class="hps">2006</span><span>,</span> <span class="hps">Vol</span> <span class="hps">4</span><span>, No. 2</span><span>, Pages</span> <span class="hps">177-185</span><span>)</span></font>. <span class="hps">But</span> <span class="hps">I found</span> <span class="hps">a review</span> <span class="hps">in this sense</span> <font size="1"><span class="hps">(Am.</span> <span class="hps">J.</span> <span class="hps">Trop</span><span>.</span> <span class="hps">Hyg</span><span>.</span><span>,</span> <span class="hps">78 (5)</span><span>,</span> <span class="hps">2008</span><span>, p</span><span>.</span> <span class="hps">745-749</span><span>)</span></font> <span class="hps">and mainly a report</span> <span class="hps">of</span> <span class="hps">three</span> <span class="hps">cases in the</span> "<span class="hps">Triangulo Mineiro"</span> <span class="hps">-</span> <span class="hps">MG</span><span>, Brazil,</span> of unforgettable <span class="hps">Prof.</span> <span class="hps">Aluizio Prata (RIP)</span> <span class="hps">who along with</span> <span class="hps">Mario</span> <span class="hps">Leon</span> <font size="1"><span class="hps atn">(</span><span>Rev.</span> <span class="hps">Inst</span><span>.</span> <span class="hps">Trop.</span> <span class="hps">S.</span> <span class="hps">Paulo</span><span class="atn">, May-</span><span>June,</span> <span class="hps">200,</span> <span class="hps">46</span> <span class="hps atn">(</span><span>3</span><span>)</span> <span class="hps">:175</span><span class="atn">-</span><span>177</span><span>)</span></font> <span class="hps">successfully used</span><span>,</span> <strong><font color="#3333ff" size="4">AZITHROMYCIN</font></strong> <span class="hps">(500</span> <span class="hps">mg/dia/10</span> <span class="hps">days</span> <span class="hps">oral) in</span> <span class="hps">patients aged</span> <span class="hps">76-80</span> <span class="hps">years of age.</span><br>
<br> <span class="hps">Hopefully</span> <span class="hps">this information can</span> <span class="hps">help you</span><span>.</span></div><div><span></span> </div><div><span>Best regards,</span></div><div><span></span> </div>
<div style="text-align:center"><span><strong>Prof. Marco Tulio A Garcia-Zapata, MD, PhD</strong></span></div><div style="text-align:center"><span><font size="1"><strong>Medical Tropicalist / Head Professor / Principal Researcher</strong></font></span></div>
<div style="text-align:center"><span><font size="1">Tropical Medicine & Dermatology Department (DMTD)</font></span></div><div style="text-align:center"><span><font size="1"><span class="hps">Center for Studies</span> <span class="hps">and Research in</span> (Re)Emerging Diseases (NUPEREME)</font></span></div>
<div style="text-align:center"><span><font size="1">Reference Sentry for International and Travel Medicine (USCREMIVI)</font></span></div><div style="text-align:center"><span><font size="1"></font></span> </div><div style="text-align:center">
<span><font size="1">Caixa Postal 12911 - Setor Leste Vila Nova</font></span></div><div style="text-align:center"><span><font size="1">Goiania - GO, 74643-970, Brazil</font></span></div><div style="text-align:center"><span><font size="1">Phone(=62)3269-8219, Fax (+62)3521-1839</font></span></div>
<div style="text-align:center"><span><font size="1">E-mail: <a href="mailto:nupereme@gmail.com">nupereme@gmail.com</a> </font></span></div><div style="text-align:center"><span><font size="1"><a href="mailto:medicinadeviagem.hc.hdt@gmail.com">medicinadeviagem.hc.hdt@gmail.com</a></font></span></div>
<div style="text-align:center"><span><font size="1"> <a href="mailto:mctulianglobal@gmail.com">mctulianglobal@gmail.com</a></font></span></div><div style="text-align:center"><span><font size="1"></font></span> </div><div>
<span></span> </div><div><span></span> </div><div><br><br></div><div class="gmail_quote">2012/4/9 Kleber Luz <span dir="ltr"><<a href="mailto:klebergluz@gmail.com">klebergluz@gmail.com</a>></span><br><blockquote style="margin:0px 0px 0px 0.8ex;padding-left:1ex;border-left-color:rgb(204,204,204);border-left-width:1px;border-left-style:solid" class="gmail_quote">
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.<span class="HOEnZb"><font color="#888888"><br clear="all">
<br>-- <br>Prof.Adjunto III - Kleber Giovanni Luz - DEPARTAMENTO DE INFECTOLOGIA/UFRN/HOSPITAL GISELDA TRIGUEIRO<br>
Rua Cônego Monte, 110 - QUINTAS<br>CEP 59037-170<br>NATAL-RN<br><b>FONE (FAX): <a value="+18432151603">(84) - 3215-1603</a><br>FONE: <a value="+18432327948">(84) - 3232-7948</a><br>CEL: (84) - 9193 - 6208</b><br> <div style="display:inline">
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