scholarly journals An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil

2021 ◽  
Vol 15 (9) ◽  
pp. e0009734
Author(s):  
Carla Oliveira-Ribeiro ◽  
Maria Inês Fernandes Pimentel ◽  
Liliane de Fátima Antonio Oliveira ◽  
Érica de Camargo Ferreira e Vasconcellos ◽  
Fatima Conceição-Silva ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Rio De Janeiro ◽  
Treatment Interruption ◽  
Complete Healing ◽  
Cutaneous Lesions ◽  
Chi Square ◽  
Standard Regimen ◽  
Historical Cohort ◽  
Reference Center ◽  
Meglumine Antimoniate

Background Treatment of cutaneous leishmaniasis (CL) remains challenging since the drugs currently used are quite toxic, thus contributing to lethality unrelated to the disease itself but to adverse events (AE). The main objective was to evaluate different treatment regimens with meglumine antimoniate (MA), in a reference center in Rio de Janeiro, Brazil. Methodology A historical cohort of 592 patients that underwent physical and laboratory examination were enrolled between 2000 and 2017. The outcome measures of effectiveness were epithelialization and complete healing of cutaneous lesions. AE were graded using a standardized scale. Three groups were evaluated: Standard regimen (SR): intramuscular (IM) MA 10–20 mg Sb5+/kg/day during 20 days (n = 46); Alternative regimen (AR): IM MA 5 mg Sb5+/kg/day during 30 days (n = 456); Intralesional route (IL): MA infiltration in the lesion(s) through subcutaneous injections (n = 90). Statistical analysis was performed through Fisher exact and Pearson Chi-square tests, Kruskal-Wallis, Kaplan-Meier and log-rank tests. Results SR, AR and IL showed efficacy of 95.3%, 84.3% and 75.9%, with abandonment rate of 6.5%, 2.4% and 3.4%, respectively. IL patients had more comorbidities (58.9%; p = 0.001), were mostly over 50 years of age (55.6%), and had an evolution time longer than 2 months (65.6%; p = 0.02). Time for epithelialization and complete healing were similar in IL and IM MA groups (p = 0.9 and p = 0.5; respectively). Total AE and moderate to severe AE that frequently led to treatment interruption were more common in SR group, while AR and IL showed less toxicity. Conclusions/Significance AR and IL showed less toxicity and may be good options especially in CL cases with comorbidities, although SR treatment was more effective. IL treatment was an effective and safe strategy, and it may be used as first therapy option as well as a rescue scheme in patients initially treated with other drugs.

scholarly journals RESOLUTION OF CUTANEOUS LEISHMANIASIS AFTER ACUTE ECZEMA DUE TO INTRALESIONAL MEGLUMINE ANTIMONIATE

2014 ◽  
Vol 56 (4) ◽  
pp. 361-362 ◽  
Author(s):  
Erica de Camargo Ferreira e Vasconcellos ◽  
Maria Inês Fernandes Pimentel ◽  
Cláudia Maria Valete-Rosalino ◽  
Maria de Fátima Madeira ◽  
Armando de Oliveira Schubach
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Amphotericin B ◽  
Rio De Janeiro ◽  
Low Dose ◽  
Reference Center ◽  
Meglumine Antimoniate ◽  
Cutaneous Hypersensitivity ◽  
Intralesional Administration ◽  
The Right

We report a case of a 42 year-old female, who came to a leishmaniasis reference center in Rio de Janeiro, Brazil, presenting a cutaneous leishmaniasis lesion in the right forearm. Treatment with low-dose intramuscular meglumine antimoniate (MA) (5 mg Sb5+/kg/day) was initiated, with improvement after 28 days, although with the development of generalized eczema. After 87 days, the lesion worsened. Patient refused treatment with amphotericin B. MA was then infiltrated in the lesion, in two sessions, resulting in local eczema, with bullae formation; however, twenty days after, both the ulcer and eczema receded. Intralesional administration of MA should be used carefully when previous cutaneous hypersensitivity is detected.

scholarly journals In Vitro Reduced Susceptibility to Pentavalent Antimonials of a Leishmania infantum Isolate from a Human Cutaneous Leishmaniasis Case in Central Italy

2021 ◽  
Vol 9 (6) ◽  
pp. 1147
Author(s):  
Aurora Diotallevi ◽  
Gloria Buffi ◽  
Giovanni Corbelli ◽  
Marcello Ceccarelli ◽  
Margherita Ortalli ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Leishmania Infantum ◽  
Histopathological Examination ◽  
Central Italy ◽  
Complete Healing ◽  
Response To Treatment ◽  
Meglumine Antimoniate ◽  
Parasitological Diagnosis ◽  
New Treatment

Cutaneous leishmaniasis (CL) caused by Leishmania (Leishmania) infantum is endemic in the Mediterranean basin. Here we report an autochthonous case of CL in a patient living in central Italy with an unsatisfactory response to treatment with intralesional Meglumine Antimoniate and in vitro demonstration of reduced susceptibility to SbIII. Parasitological diagnosis was first achieved by histopathology on tissue biopsy and the patient was treated with a local infiltration of Meglumine Antimoniate. Since the clinical response at 12 weeks from the treatment’s onset was deemed unsatisfactory, two further skin biopsies were taken for histopathological examination, DNA extraction and parasite isolation. L. (L.) infantum was identified by molecular typing. The low susceptibility to Meglumine Antimoniate was confirmed in vitro: the promastigotes from the patient strain showed significantly lower susceptibility to SbIII (the active trivalent form of antimonial) compared to the reference strain MHOM/TN/80/IPT1. The patient underwent a new treatment course with intravenous liposomal Amphotericin B, reaching complete healing of the lesion. Additional studies are needed to confirm the epidemiological and clinical relevance of reduced susceptibility to SbIII of human L. (L.) infantum isolate in Italy.

scholarly journals Intralesional Meglumine Antimoniate for Treatment of Cutaneous Leishmaniasis Patients with Contraindication to Systemic Therapy from Rio de Janeiro (2000 to 2006)

2012 ◽  
Vol 87 (2) ◽  
pp. 257-260 ◽  
Author(s):  
Érica de Camargo Ferreira e Vasconcellos ◽  
Maria de Fátima Madeira ◽  
Raquel de Vasconcellos Carvalhaes de Oliveira ◽  
Armando de Oliveira Schubach ◽  
Maria Inês Fernandes Pimentel ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Systemic Therapy ◽  
Rio De Janeiro ◽  
Meglumine Antimoniate

scholarly journals Empty shelves: selected essential medicines stockouts in South Africa

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Wolvaardt ◽  
R Nemuntandani ◽  
I Kamungoma-Dada
Keyword(s):  
South Africa ◽  
Urban Areas ◽  
Descriptive Analysis ◽  
Secondary Data ◽  
Treatment Interruption ◽  
Cross Sectional Study ◽  
Essential Medicines ◽  
Chi Square ◽  
Cross Sectional ◽  
Antiretroviral Medication

Abstract Background Access to essential medicines in South Africa has been compromised by stockouts in health facilities. This study describes the occurrence of stockouts for a selection of essential medicines. Methods This cross-sectional study used secondary data retrieved from the Stop Stock Outs Project (SSP). A descriptive analysis was conducted on data from the 2013-2015 SSP case management database of routinely reported stockouts. Chi square tests of independence was conducted on data from the SSP 2015 annual telephonic survey to investigate associations between the occurrence of stockouts, the level of health facility and the type of health professional. Results 231 facilities reported 609 stockouts. Antiretroviral medication had the most stockout reports (78%; n = 475/609), followed by anti-infectives (17.1%; n = 104/609) and tuberculosis medication (4.9%; n = 30/609). The highest number of stockout reports were received from Gauteng province and the majority (71.09%; n = 150/211) of facilities reporting stockouts were in urban areas. There were more stockouts at ambulatory, rather than inpatient care, facilities however, this was not statistically significant. Conclusions This study confirms that South Africa experiences medicine stockouts for many of the essential medicines, with antiretroviral medication being the category most affected. The stockouts vary between provinces and the urban-rural divide but are an equal threat to both ambulatory and inpatient facilities. Key messages The pattern of stockouts experienced over a three-year period suggest that stockouts are ‘normal’ despite the substantive effects of treatment interruption – especially patients with HIV and/or TB. Antiretroviral therapy is at risk as a result of stockouts.

scholarly journals FACTORS ASSOCIATED TO ADHERENCE TO DIFFERENT TREATMENT SCHEMES WITH MEGLUMINE ANTIMONIATE IN A CLINICAL TRIAL FOR CUTANEOUS LEISHMANIASIS

2014 ◽  
Vol 56 (4) ◽  
pp. 291-296 ◽  
Author(s):  
Madelon Novato Ribeiro ◽  
Maria Inês Fernandes Pimentel ◽  
Armando de Oliveira Schubach ◽  
Raquel de Vasconcellos Carvalhães de Oliveira ◽  
José Liporage Teixeira ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cutaneous Leishmaniasis ◽  
Low Dose ◽  
Lower Number ◽  
Adherence To Treatment ◽  
Simple Method ◽  
Meglumine Antimoniate ◽  
Factors Associated ◽  
Adherence Monitoring ◽  
Socioeconomic Data

The favorable outcome of the treatment of a disease is influenced by the adherence to therapy. Our objective was to assess factors associated with adherence to treatment of patients included in a clinical trial of equivalence between the standard and alternative treatment schemes with meglumine antimoniate (MA) in the treatment of cutaneous leishmaniasis (CL), in the state of Rio de Janeiro. Between 2008 and 2011, 57 patients with CL were interviewed using a questionnaire to collect socioeconomic data. The following methods were used for adherence monitoring: counting of vial surplus, monitoring card, Morisky test and modified Morisky test (without the question regarding the schedule); we observed 82.1% (vial return), 86.0% (monitoring card), 66.7% (Morisky test) and 86.0% (modified Morisky test) adherence. There was a strong correlation between the method of vial counting and the monitoring card and modified Morisky test. A significant association was observed between greater adherence to treatment and low dose of MA, as well as with a lower number of people sleeping in the same room. We recommend the use of the modified Morisky test to assess adherence to treatment of CL with MA, because it is a simple method and with a good performance, when compared to other methods.

Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis caused by Leishmania braziliensis

2021 ◽  
Author(s):  
Tainã Lago ◽  
Lucas Carvalho ◽  
Mauricio Nascimento ◽  
Luiz H Guimarães ◽  
Jamile Lago ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Clinical Presentation ◽  
Clinical Manifestations ◽  
Healing Time ◽  
Response To Therapy ◽  
Leishmania Braziliensis ◽  
Cutaneous Lesions ◽  
Cytokine Levels ◽  
Cure Rates ◽  
The Impact

Abstract Background Cutaneous leishmaniasis (CL) caused by L. braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates below 60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. Methods A total of 90 age-matched CL patients were included (30 obese, 30 overweight and 30 with normal BMI). CL was diagnosed through documentation of L. braziliensis DNA by PCR or identification of amastigotes in biopsied skin lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (20mg/kg/day) was administered for 20 days. Results Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After one course of Antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (p<0.01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (p<0.05). Conclusions Obesity modifies the clinical presentation of CL and host immune response, and is associated with greater failure to therapy.

scholarly journals Intralesional meglumine antimoniate for the treatment of localised cutaneous leishmaniasis: a retrospective review of a Brazilian referral centre

2016 ◽  
Vol 111 (8) ◽  
pp. 512-516 ◽  
Author(s):  
Rosiana Estéfane da Silva ◽  
Antonio Toledo Júnior ◽  
Maria Camilo Senna ◽  
Ana Rabello ◽  
Gláucia Cota
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Retrospective Review ◽  
Referral Centre ◽  
Meglumine Antimoniate

scholarly journals Comparison of Oral Zinc Sulfate with Systemic Meglumine Antimoniate in the Treatment of Cutaneous Leishmaniasis

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Mohamad Javad Yazdanpanah ◽  
Mahnaz Banihashemi ◽  
Fakhrozaman Pezeshkpoor ◽  
Mohammad Khajedaluee ◽  
Sororozaman Famili ◽  
...  
Keyword(s):  
Side Effects ◽  
Cutaneous Leishmaniasis ◽  
Side Effect ◽  
Zinc Sulfate ◽  
Cure Rate ◽  
Meglumine Antimoniate ◽  
Treatment Groups ◽  
Significant Difference

The purpose of this study was to investigate comparison between oral zinc sulfate and meglumine antimoniate in the treatment of cutaneous leishmaniasis (CL). So 100 patients with CL were included and randomly divided into two groups. The first group was treated with oral zinc sulfate (10 mg/kg/day during 45 days period), and the second group was treated with systemic meglumine antimoniate (20 mg/kg/day intramuscularly for 20 days). Acceptable cure after completing 45 days of followup occurred in 30.2% of lesions in first group, while this was 35.5% for the second group. There is not any significant difference between the two treatment groups (P=0.42). Serious side effects resulting in treatment discounting occurred in only meglumine antimoniate group. Although cure rate of systemic meglumine antimoniate group was better the treatment with zinc sulfate is much easier, cheaper, more convenient in consumption, safer, and nearly close cure percentage to systemic meglumine antimoniate injections without serious side effect.

Sign in / Sign up

Export Citation Format

Share Document