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<p>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</p>
<p>Best regards</p>
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<p>&nbsp;</p>
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<p><strong>Dr. Tomás A. Orduna</strong><br>
Jefe de Servicio <br>
Patologías Regionales y Medicina Tropical (CEMPRA-MT)<br>
Hospital de Infecciosas F. J. Muñiz<br>
Uspallata 2272 (C.P. 1282)<br>
Buenos Aires - Argentina<br>
T.E.:(54-11) 4305-3161<br>
T.E.:Conmutador:(&#43;54-11) 4305-0357/1944(int.231)<br>
Fax: (&#43;54-11) 4304-2386<br>
<a tabindex="0" href="mailto:torduna@intramed.net" target="">torduna@intramed.net</a></p>
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<div style="DIRECTION: ltr" id="divRpF223296"><font color="#000000" size="2" face="Tahoma"><b>De:</b> tropmed-l-bounces@lineu.icb.usp.br [tropmed-l-bounces@lineu.icb.usp.br] en nombre de Marco Tulio Antonio Garciazapata [mctulianglobal@gmail.com]<br>
<b>Enviado el:</b> martes, 17 de abril de 2012 17:29<br>
<b>Para:</b> Kleber Luz<br>
<b>CC:</b> tropmed-L@lineu.icb.usp.br<br>
<b>Asunto:</b> Re: [Tropmed-l] LV patiente 92y old<br>
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<span lang="EN-US"><font size="3"><font face="Calibri">Kleber,</font></font></span></p>
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<span lang="EN-US"><font size="3" face="Calibri"></font></span>&nbsp;</p>
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<p style="TEXT-ALIGN: justify; LINE-HEIGHT: normal; MARGIN: 0cm 0cm 0pt; BACKGROUND: white" class="MsoNormal">
<font face="Calibri"><font size="3"><span class="hps"><span style="COLOR: rgb(51,51,51)" lang="EN">Through</span></span><span style="COLOR: rgb(51,51,51)" lang="EN">
<span class="hps">cyber</span> <span class="hps">and</span> by <span class="hps">
courtesy of</span> <strong><span class="hps">Jenny</span> <span class="hps">F</span>
<span class="hps">Laskarzewsky</span></strong>, Pharm. </span><span class="hps"><span style="COLOR: rgb(51,51,51)" lang="EN-US">D</span></span><span style="COLOR: rgb(51,51,51)" lang="EN-US">, BCPS</span>
</font><span style="COLOR: rgb(51,51,51); FONT-SIZE: 8pt" lang="EN-US">(Clinical Pharmacist at San Ramon Regional Medical Center /
</span><span class="hps"><span style="COLOR: rgb(51,51,51); FONT-SIZE: 8pt" lang="EN">San Francisco Bay</span></span><span style="COLOR: rgb(51,51,51); FONT-SIZE: 8pt" lang="EN">
<span class="hps">Region</span>, United States) </span><font size="3"><span class="hps"><span style="COLOR: rgb(51,51,51)" lang="EN">have just received</span></span><span style="COLOR: rgb(51,51,51)" lang="EN">
<span class="hps">another</span> <span class="hps">information that</span> <span class="hps">
may</span> <span class="hps">be of interest</span> </span><span lang="EN-US">an unrandomized trial
<span style="BACKGROUND: aqua">&quot;Treatment of Bolivian mucosal leishmaniasis with miltefosine&quot;</span>
</span></font><span style="FONT-SIZE: 8pt" lang="EN-US">(<b><span style="COLOR: rgb(0,51,204)">Soto J, et al Clinical Infectious Diseases. 2007;44(3);350)</span></b></span><span lang="EN-US"><font size="3"> concluded that the cure rate for
<font color="#3333ff" size="6"><strong>miltefosine</strong></font> </font></span><span style="FONT-SIZE: 8pt" lang="EN-US">(<b><span style="COLOR: rgb(0,51,204)">2.5 mg/kg/day (Max=150 mg/day) for 28 days</span></b>)
</span><span lang="EN-US"><font size="3">was equivalent to parenteral Amphotericin B, with its toxicity profile is far superior to that of amphotericin B.<span>&nbsp;
</span></font></span></font></p>
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<span lang="EN-US"><font size="3" face="Calibri"></font></span>&nbsp;</p>
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<span lang="EN-US"><font size="3"><font face="Calibri"><strong>Prof. Marco Tulio A Garcia-Zapata, MD, PhD</strong></font></font></span></p>
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<span style="FONT-SIZE: 8pt" lang="EN-US"><font face="Calibri">Medical Tropicalist / Head Professor / Principal Researcher</font></span></p>
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<span style="FONT-SIZE: 8pt" lang="EN-US"><font face="Calibri">Tropical Medicine &amp; Dermatology Department (DMTD)</font></span></p>
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<span style="FONT-SIZE: 8pt" lang="EN-US"><font face="Calibri">Center for Studies and Research in (Re)Emerging Diseases (NUPEREME)</font></span></p>
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<span style="FONT-SIZE: 8pt" lang="EN-US"><font face="Calibri">Reference Sentry for International and Travel Medicine (USCREMIVI)</font></span></p>
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<span style="FONT-SIZE: 8pt"><font face="Calibri">Caixa Postal 12911 - Setor Leste Vila Nova</font></span></p>
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<span style="FONT-SIZE: 8pt" lang="EN-US"><font face="Calibri">Goiania - GO, 74643-970, Brazil</font></span></p>
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<span style="FONT-SIZE: 8pt" lang="EN-US"><font face="Calibri">Phone(=62)3269-8219, Fax (&#43;62)3521-1839</font></span></p>
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<p style="TEXT-ALIGN: center; LINE-HEIGHT: normal; MARGIN: 0cm 0cm 0pt" class="MsoNormal" align="center">
<span style="FONT-SIZE: 8pt"><font face="Calibri">E-mail: <a href="mailto:nupereme@gmail.com" target="_blank">
nupereme@gmail.com</a> </font></span></p>
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<span style="FONT-SIZE: 8pt"><font face="Calibri"><a href="mailto:medicinadeviagem.hc.hdt@gmail.com" target="_blank">medicinadeviagem.hc.hdt@gmail.com</a>
</font></span></div>
<div style="TEXT-ALIGN: center; LINE-HEIGHT: normal; MARGIN: 0cm 0cm 0pt" class="MsoNormal" align="center">
<span style="FONT-SIZE: 8pt"><font face="Calibri"><a href="mailto:mctulianglobal@gmail.com" target="_blank">mctulianglobal@gmail.com</a>
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<p style="TEXT-ALIGN: center"><font size="3" face="Times New Roman"></font><br>
<font size="6">***************</font><br>
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<div class="gmail_quote">2012/4/15 Marco Tulio Antonio Garciazapata <span dir="ltr">
&lt;<a href="mailto:mctulianglobal@gmail.com" target="_blank">mctulianglobal@gmail.com</a>&gt;</span><br>
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<div>Kleber,</div>
<div>&nbsp;</div>
<div><span>Your&nbsp;case</span> <span>can be</span> <span>a</span> <span>&quot;</span><span>Record&quot;</span>
<span>in the literature.</span> W<span>e have to</span> <span>offer some kind of</span>
<span>solution and</span> <span>quickly.</span> Due<span>&nbsp;we do not</span> <span>
have much experience</span> <span>in the treatment</span> <span>of leishmaniasis</span>
<span>in the elderly population</span><span>.</span> <span>Worried</span><span>, I</span><span>&nbsp;found that</span>
<span>there are</span> <span>few studies</span> <span>that deal with</span> <span>
the issue</span><span>.</span></div>
<span></span>
<div><br>
&nbsp;<span>It is well</span> <span>known</span> <span>effectiveness</span> <span>in the treatment</span>
<span>of leishmaniasis</span><span>,</span> <span>in general, with</span> <span>the group of</span>
<span>antimonial</span> <span>drugs</span> <span>and /</span> <span>or</span> <span>
derivatives</span> <span>of amphotericin B</span><span>,</span> <span>but without</span>
<span>doubt,</span> <span>are very</span> <span>toxic and</span> <span>not recommended</span>
<span>in these patients</span><span>.</span></div>
<span></span>
<div><br>
&nbsp;<span>In the treatment of</span> <span>invasive fungal infections</span> <span>in the elderly</span>
<font size="1"><span>(</span><span>Aging and</span> <span>infectious diseases</span><span>, 15 August,&nbsp;CID</span>
<span>2001:33</span><span>)</span></font><span><font size="1">,</font> <strong>lipid formulations of</strong></span><strong>
<span>amphotericin</span> <span>B</span></strong> <font size="1"><span>(</span><span>liposome/&quot;Ambisome&quot;</span><span>,</span>
<span>lipid complex/&quot;Abelcet&quot; and</span> <span>colloidal dispersion</span> <span>
B/&quot;Amphotec&quot; or &quot;Amphocil&quot;</span><span>)</span><span>,</span></font> <span>would be</span> the drugs
<span>recommended</span><span>,</span> <span>but at</span> <span>high cost</span><span>,</span>
<span>are not</span> <span>the</span> <span>choice</span><span>.</span> E<span>xpected</span>
<span>in the coming</span> <span>years, the</span> goianan <span>pharmaceutical industry</span>&nbsp;<span>available at the</span> national<span> market</span>
<span>such</span> <span>formulations</span> <span>result of</span> <span>promising</span>
<span>studies</span> <span>in nanotechnology</span> <span>made ​​by</span> <span>
Faculty of Pharmacy&nbsp;/</span> <span>Federal University of Goias, Brazil</span><span>.</span></div>
<span></span>
<div><br>
&nbsp;<span>In this case</span> <span>the recommendation</span> <span>is to use</span>
<span><strong><font size="4">alternative drug</font></strong></span><span>, in spite</span>
<span>of being</span> <span>less toxic and</span> <span>less effective,</span> <span>
can be</span> <span>invaluable</span> <span>in such</span> <span>patients.</span>
<font color="#3333ff"><strong><span>&quot;</span><span>Primum non</span> <span>nocere&quot;!!!</span></strong></font>
<span>Draws</span> <span>attention to</span> <span>the</span> <span>subject with</span>
<span>very little experience</span> <span>using</span> <span><strong><font size="4">MILTEFOSINE</font></strong></span><span>, the 1st</span>
<span>anti</span><span>-</span><span>leishmania</span> <span>drugs</span> <span>more effective</span>
<span>oral</span> <font size="1"><span>(Expert</span> <span>Review of</span> <span>
Anti</span><span>-</span><span>infective</span> <span>Therapy</span><span>, April</span>
<span>2006</span><span>,</span> <span>Vol</span> <span>4</span><span>, No. 2</span><span>, Pages</span>
<span>177-185</span><span>)</span></font>. <span>But</span> <span>I found</span> <span>
a review</span> <span>in this sense</span> <font size="1"><span>(Am.</span> <span>
J.</span> <span>Trop</span><span>.</span> <span>Hyg</span><span>.</span><span>,</span>
<span>78 (5)</span><span>,</span> <span>2008</span><span>, p</span><span>.</span>
<span>745-749</span><span>)</span></font> <span>and mainly a report</span> <span>
of</span> <span>three</span> <span>cases in the</span> &quot;<span>Triangulo Mineiro&quot;</span>
<span>-</span> <span>MG</span><span>, Brazil,</span> of unforgettable <span>Prof.</span>
<span>Aluizio Prata (RIP)</span>&nbsp;<span>who along with</span> <span>Mario</span> <span>
Leon</span> <font size="1"><span>(</span><span>Rev.</span> <span>Inst</span><span>.</span>
<span>Trop.</span> <span>S.</span> <span>Paulo</span><span>, May-</span><span>June,</span>
<span>200,</span> <span>46</span> <span>(</span><span>3</span><span>)</span> <span>
:175</span><span>-</span><span>177</span><span>)</span></font> <span>successfully used</span><span>,</span>
<strong><font color="#3333ff" size="4">AZITHROMYCIN</font></strong> <span>(500</span>
<span>mg/dia/10</span> <span>days</span> <span>oral) in</span> <span>patients aged</span>
<span>76-80</span> <span>years of age.</span><br>
<br>
<span>Hopefully</span> <span>this information can</span> <span>help you</span><span>.</span></div>
<div><span></span>&nbsp;</div>
<div><span>Best regards,</span></div>
<div><span></span>&nbsp;</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 &amp; Dermatology Department (DMTD)</font></span></div>
<div style="TEXT-ALIGN: center"><span><font size="1"><span>Center for Studies</span>
<span>and Research in</span> (Re)Emerging Diseases (NUPEREME)</font></span></div>
<div style="TEXT-ALIGN: center"><span><font size="1">Reference Sentry Unit for International and Travel Medicine (USCREMIVI)</font></span></div>
<div style="TEXT-ALIGN: center"><span><font size="1">Teaching&nbsp;Hospital / Tropical Pathology &amp; Public Health Institute (IPTSP)</font></span></div>
</blockquote>
<div style="TEXT-ALIGN: center"><font size="1">Federal University of Goias, Brazil&nbsp;(<span>UFG)</span></font></div>
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<div style="TEXT-ALIGN: center"><span><font size="1"></font></span>&nbsp;</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(=<a href="tel:62%293269-8219" target="_blank" value="&#43;16232698219">62)3269-8219</a>, Fax
<a href="tel:%28%2B62%293521-1839" target="_blank" value="&#43;6235211839">(&#43;62)3521-1839</a></font></span></div>
<div style="TEXT-ALIGN: center"><span><font size="1">E-mail: <a href="mailto:nupereme@gmail.com" target="_blank">
nupereme@gmail.com</a> </font></span></div>
<div style="TEXT-ALIGN: center"><span><font size="1"><a href="mailto:medicinadeviagem.hc.hdt@gmail.com" target="_blank">medicinadeviagem.hc.hdt@gmail.com</a></font></span></div>
<div style="TEXT-ALIGN: center"><span><font size="1">&nbsp;<a href="mailto:mctulianglobal@gmail.com" target="_blank">mctulianglobal@gmail.com</a></font></span></div>
<div style="TEXT-ALIGN: center"><span><font size="1"></font></span>&nbsp;</div>
<div><span></span>&nbsp;</div>
<div><span></span>&nbsp;</div>
<div><br>
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<div class="gmail_quote">2012/4/9 Kleber Luz <span dir="ltr">&lt;<a href="mailto:klebergluz@gmail.com" target="_blank">klebergluz@gmail.com</a>&gt;</span><br>
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<div>
<div class="h5">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><font color="#888888"><br clear="all">
<br>
-- <br>
Prof.Adjunto III -&nbsp; 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="&#43;18432151603">(84) - 3215-1603</a><br>
FONE: <a value="&#43;18432327948">(84) - 3232-7948</a><br>
CEL: (84) - 9193 - 6208</b><br>
&nbsp;
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