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 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 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.

Treatment of cutaneous leishmaniasis with a combination of allopurinol and low-dose meglumine antimoniate

2002 ◽  
Vol 41 (7) ◽  
pp. 441-443 ◽  
Author(s):  
Ali Z. Momeni ◽  
Mohamad Reza Reiszadae ◽  
Malihalsadat Aminjavaheri
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Low Dose ◽  
Meglumine Antimoniate

scholarly journals In VitroSensitivity of PairedLeishmania(Viannia)braziliensisSamples Isolated before Meglumine Antimoniate Treatment and after Treatment Failure or Reactivation of Cutaneous Leishmaniasis

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Cibele Baptista ◽  
Luciana de Freitas Campos Miranda ◽  
Maria de Fátima Madeira ◽  
Leonor Laura Pinto Leon ◽  
Fátima Conceição-Silva ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Cutaneous Leishmaniasis ◽  
Drug Exposure ◽  
Lethal Dose ◽  
Poor Response ◽  
Leishmania Braziliensis ◽  
Meglumine Antimoniate ◽  
Intralesional Administration ◽  
The Difference

This study evaluated thein vitrosensitivity of pairedLeishmania braziliensissamples isolated from the same patient before pentavalent antimonial treatment (Sample A) and after treatment failure or cutaneous leishmaniasis reactivation (Sample B) in patients undergoing intralesional administration or injections (5 mgSbV/kg/d) of meglumine antimoniate. Fourteen samples from 7 patients were studied. After 24 h of drug exposure, 50% lethal dose (LD50) values for promastigotes ranged from 0.37 mg/mL to 5.86 mg/mL for samples obtained before treatment (A) and 0.89 mg/mL to 7.80 mg/mL for samples obtained after treatment (B). After 48 h, LD50values ranged from 0.37 mg/mL to 5.75 mg/mL and 0.70 mg/mL to 7.68 mg/mL for A and B samples, respectively. After 48 h, LD50values for amastigotes ranged from 11.7 to 44.3 μg/mL for A samples and 13.7 to 52.7 μg/mL for B samples. Of 7 patients, 1 discontinued treatment and 6 were cured after retreatment with amphotericin B (4 cases) or meglumine antimoniate (2 cases). Overall the B samples had higher LD50values than A samples; however the difference was not significant. These results do not support the hypothesis that low-dose and intralesional treatments induce selection of resistant parasitesin vitroand suggest that other factors may influence therapeutic outcome in patients with poor response to initial treatment.

Risk factors associated with dizziness during treatment of mucosal leishmaniasis with meglumine antimoniate: 16-year retrospective study of cases from Rio de Janeiro, Brazil

2010 ◽  
Vol 124 (10) ◽  
pp. 1056-1060 ◽  
Author(s):  
M H Araujo-Melo ◽  
A M Meneses ◽  
A O Schubach ◽  
J S Moreira ◽  
F Conceição-Silva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Rio De Janeiro ◽  
Low Dose ◽  
Elevated Serum ◽  
Serum Lipase ◽  
Elderly Individuals ◽  
Meglumine Antimoniate ◽  
Factors Associated ◽  
Mucosal Leishmaniasis

AbstractObjective:To evaluate dizziness in patients receiving meglumine antimoniate for the treatment of mucosal leishmaniasis.Materials and methods:We retrospectively studied 127 patients treated at the Laboratory of Leishmaniasis Surveillance, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, between 1 January 1989 and 31 December 2004.Results:A low dose of meglumine antimoniate (5 mg/kg/day) was used in 86.6 per cent of patients; a dose of 10 mg/kg/day or higher was used in 13.4 per cent of patients. Dizziness was reported by 4.7 per cent of patients. The adjusted odds ratios were 7.37 for dizziness in female patients, 4.9 for dizziness in patients aged 60 years or older, and 7.77 for dizziness in the presence of elevated serum lipase.Conclusion:We suggest that dizziness may be a side effect of meglumine antimoniate, particularly in elderly individuals, in females and in patients with elevated serum lipase.

scholarly journals American cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis resistant to meglumine antimoniate, but with good response to pentamidine: a case report

2011 ◽  
Vol 44 (2) ◽  
pp. 254-256 ◽  
Author(s):  
Maria Inês Fernandes Pimentel ◽  
Cibele Baptista ◽  
Évelyn Figueiredo Rubin ◽  
Érica de Camargo Ferreira e Vasconcellos ◽  
Marcelo Rosandiski Lyra ◽  
...  
Keyword(s):  
Case Report ◽  
Cutaneous Leishmaniasis ◽  
Amphotericin B ◽  
Meglumine Antimoniate ◽  
American Cutaneous Leishmaniasis ◽  
Systemic Treatments ◽  
Poor Tolerance

This is a case report of a Brazilian soldier with cutaneous leishmaniasis. The lesion relapsed following two systemic treatments with meglumine antimoniate. The patient was treated with amphotericin B, which was interrupted due to poor tolerance. Following isolation of Leishmania sp., six intralesional infiltrations of meglumine antimoniate resulted in no response. Leishmania sp promastigotes were again isolated. The patient was submitted to intramuscular 4mg/kg pentamidine. Parasites from the first and second biopsies were identified as Leishmania (Viannia) braziliensis; those isolated from the first biopsy were more sensitive to meglumine antimoniate in vitro than those isolated from the second biopsy. No relapse was observed.

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