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Cavalcante MDSM, Rodríguez KL, Diéguez JAL, Santos LMD, Guerra MDGVB, Guerra JADO. Ramsey hunt syndrome after antimonial treatment for American Cutaneous Leishmaniasis. Rev Soc Bras Med Trop 2021; 54:e20200012. [PMID: 33206873 PMCID: PMC7670763 DOI: 10.1590/0037-8682-0012-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/19/2020] [Indexed: 11/21/2022] Open
Abstract
Ramsay Hunt Syndrome (RHS), also known as herpes zoster oticus, is caused by the reactivation of varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve. Herein, we report a case of Ramsey Hunt Syndrome in a patient after antimonial treatment for Cutaneous Leishmaniasis. The patient presented with microvesicles grouped on an erythematous base, starting in the neck and ascending towards the scalp margin on the right side of the head. The patient also developed grade V peripheral facial palsy the day after initiating the herpes zoster treatment, this outcome corroborated the assumption of Ramsey Hunt Syndrome.
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Affiliation(s)
| | - Karina López Rodríguez
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brasil
| | | | - Luciana Mendes dos Santos
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brasil; Universidade Federal do Amazonas, Brasil
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2
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Mendes L, Guerra JO, Costa B, Silva ASD, Guerra MDGB, Ortiz J, Doria SS, Silva GVD, de Jesus DV, Barral-Netto M, Penna G, Carvalho EM, Machado PRL. Association of miltefosine with granulocyte and macrophage colony-stimulating factor (GM-CSF) in the treatment of cutaneous leishmaniasis in the Amazon region: A randomized and controlled trial. Int J Infect Dis 2020; 103:358-363. [PMID: 33253864 DOI: 10.1016/j.ijid.2020.11.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To compare topical granulocyte and macrophage colony-stimulating factor (GM-CSF) and miltefosine (G + M) versus placebo and miltefosine (P + M) or parenteral meglumine antimoniate (MA) in the treatment of 150 patients with cutaneous leishmaniasis (CL) caused by Leishmania guyanensis in the Amazon. DESIGN A randomized and double-blinded clinical trial. RESULTS At 90 days after the initiation of therapy, the cure rates were 66%, 58%, and 52% for the groups P + M, G + M, and MA, respectively (p > 0.05). Cure rates at 180 days did not differ. Healing time was similar in the 3 groups, but faster in the MA group as compared to the G + M group (p = 0.04). Mild and transitory systemic adverse events were frequent in all groups (above 85%). Nausea (85%) and vomiting (39%) predominated in the miltefosine groups and arthralgia (51%) and myalgia (48%) in the MA group. One patient (group MA) stopped treatment after presenting with fever, exanthema, and severe arthralgia. CONCLUSIONS Miltefosine did not present a higher cure rate than MA, and the association of GM-CSF did not improve the therapeutic response. Nevertheless, because of its less toxicity, easier administration, and a similar cure rate when compared with MA, miltefosine should remain as one of the main drugs for treating CL due to L. guyanensis. (Clinicaltrials.gov Identifier NCT03023111).
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Affiliation(s)
- Luciana Mendes
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil; Universidade Federal do Amazonas, Brazil
| | - Jorge Oliveira Guerra
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | | | - Aríneia Soares da Silva
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Maria das Graças Barbosa Guerra
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Jéssica Ortiz
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Susan Smith Doria
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - George Villarouco da Silva
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Denison Vital de Jesus
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | | | - Gerson Penna
- Núcleo de Medicina Tropical, Universidade de Brasília (UnB), Brasília-DF, e Escola Fiocruz de Governo, Fundação Oswaldo Cruz Brasília, Brazil
| | - Edgar M Carvalho
- Instituto Gonçalo Moniz (IGM), FIOCRUZ, Bahia, Brazil; Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
| | - Paulo R L Machado
- Instituto Gonçalo Moniz (IGM), FIOCRUZ, Bahia, Brazil; Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil.
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An I, Harman M, Esen M, Çelik H. The effect of pentavalent antimonial compounds used in the treatment of cutaneous leishmaniasis on hemogram and biochemical parameters. Cutan Ocul Toxicol 2019; 38:294-297. [DOI: 10.1080/15569527.2019.1610887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Isa An
- Department of Dermatology, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Mehmet Harman
- Department of Dermatology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Mustafa Esen
- Department of Dermatology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Hakim Çelik
- Department of Physiology, Harran University Medical Faculty, Sanlıurfa, Turkey
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Barros AB, Rodrigues AM, Batista MP, Munhoz Junior S, Hueb M, Fontes CJ. Varicella zoster virus reactivation during or immediately following treatment of tegumentary leishmaniasis with antimony compounds. Mem Inst Oswaldo Cruz 2014; 109:499-501. [PMID: 25004145 PMCID: PMC4155856 DOI: 10.1590/0074-0276130563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 05/02/2014] [Indexed: 12/12/2022] Open
Abstract
Antimony compounds are the cornerstone treatments for tegumentary leishmaniasis. The
reactivation of herpes virus is a side effect described in few reports. We conducted
an observational study to describe the incidence of herpes zoster reactivation during
treatment with antimony compounds. The global incidence of herpes zoster is
approximately 2.5 cases per 1,000 persons per month (or 30 cases per 1,000 persons
per year). The estimated incidence of herpes zoster in patients undergoing antimony
therapy is higher than previously reported.
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Affiliation(s)
- Andrea Barbieri Barros
- Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | - Alex Miranda Rodrigues
- Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | - Mariane Pereira Batista
- Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | - Sidney Munhoz Junior
- Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | - Marcia Hueb
- Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | - Cor Jesus Fontes
- Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
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Blum J, Buffet P, Visser L, Harms G, Bailey MS, Caumes E, Clerinx J, van Thiel PPAM, Morizot G, Hatz C, Dorlo TPC, Lockwood DNJ. LeishMan recommendations for treatment of cutaneous and mucosal leishmaniasis in travelers, 2014. J Travel Med 2014; 21:116-29. [PMID: 24745041 DOI: 10.1111/jtm.12089] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Treatment of cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML) in travelers is still controversial. Over the last decade, national and international consortia have published recommendations for treating CL in travelers. These guidelines harmonize many issues, but there are some discrepancies. METHODS Leishmania parasites causing CL can now be genotyped by polymerase chain reaction techniques for detecting Leishmania DNA. Therefore, treatment recommendations can now be species based rather than based on geographical exposure. To review the evidence on which the recommendations were based, "LeishMan" (Leishmaniasis Management), a group of experts from 13 institutions in eight European countries, performed a PubMed MEDLINE) literature search and considered unpublished evidence and the experts' own personal experiences. The Oxford evidence grading system was used to evaluate the information. RESULTS AND CONCLUSION In this article, the authors provide practical treatment recommendations for imported CL and ML in Europe, drawn up from the review by the European experts.
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Blum J, Lockwood DNJ, Visser L, Harms G, Bailey MS, Caumes E, Clerinx J, van Thiel PPAM, Morizot G, Hatz C, Buffet P. Local or systemic treatment for New World cutaneous leishmaniasis? Re-evaluating the evidence for the risk of mucosal leishmaniasis. Int Health 2013; 4:153-63. [PMID: 24029394 DOI: 10.1016/j.inhe.2012.06.004] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This review addresses the question of whether the risk of developing mucosal leishmaniasis (ML) warrants systemic treatment in all patients with New World cutaneous leishmaniasis (CL) or whether local treatment might be an acceptable alternative. The risk of patients with New World CL developing ML after the initial infection has been the main argument for systemic treatment. However, this statement needs re-evaluation and consideration of all the available data. The putative benefit of preventing ML should outweigh the toxicity of systemic antileishmanial therapy. To assess the need for and risk of systemic treatment the following factors were reviewed: the incidence and prevalence of ML in endemic populations and in travellers; the severity of mucosal lesions; the efficacy of current options to treat ML; the toxicity and, to a lesser extent, the costs of systemic treatment; the risk of developing ML after local treatment; and the strengths and limitations of current estimates of the risk of developing ML in different situations. Local treatment might be considered as a valuable treatment option for travellers suffering from New World CL, provided that there are no risk factors for developing ML such as multiple lesions, big lesions (>4 cm(2)), localisation of the lesion on the head or neck, immunosuppression or acquisition of infection in the high Andean countries, notably Bolivia.
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Affiliation(s)
- Johannes Blum
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
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Llanos-Cuentas A, Valencia BM, Petersen CA. Neurological manifestations of human leishmaniasis. HANDBOOK OF CLINICAL NEUROLOGY 2013; 114:193-8. [DOI: 10.1016/b978-0-444-53490-3.00013-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Monitoring toxicity associated with parenteral sodium stibogluconate in the day-case management of returned travellers with New World cutaneous leishmaniasis [corrected]. PLoS Negl Trop Dis 2012; 6:e1688. [PMID: 22745840 PMCID: PMC3383730 DOI: 10.1371/journal.pntd.0001688] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 04/30/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with New World cutaneous leishmaniasis (NWCL) caused by Leishmania Viannia are treated with parenteral sodium stibogluconate (SbV) to reduce the risk of development of mucocutanous leishmaniasis. Our centre manages patients with NWCL on an outpatient-basis. This study was conducted to assess the safety and efficacy of this approach. METHODOLOGY We reviewed records of 67 consecutive NWCL patients, aged 17-61 years, treated as day-cases with 20 mg/kg/day SbV for up to 28 days at our UK centre. Data had been collected in a standardised format at the time of treatment using a care-record tool. Patients reported adverse-effects daily using a structured questionnaire. Blood tests and electrocardiograms were performed twice weekly to monitor for toxicity. PRINCIPAL FINDINGS Parenteral SbV treatment was associated with an early, significant suppression of mean lymphocyte and platelet counts. By day four of treatment, lymphocytes reduced by 0.53×10(9)/L (CI 0.29×10(9)/L to 0.76×10(9)/L, p<0.001), and platelets by 31,000/µL (CI 16,000/µL to 46,000/µL, p<0.001). SbV was further associated with significant elevation of serum alanine transaminase concentrations, with a mean peak rise of 107 iu/L by day 13 (CI 52 iu/L to 161 iu/L, p<0.001). These disturbances were temporary and did not result in adverse clinical events. Patient-described symptoms were cumulative and at three weeks of treatment, 59.6% of patients experienced myalgia and 29.8% malaise. Treatment adherence and clinical outcomes were comparable to inpatient treatment studies. A total of 1407 individual doses of SbV resulted in only 26 nights' hospital admission, a saving of 1381 bed-days compared to inpatient treatment. CONCLUSIONS/SIGNIFICANCE In specialist centres, NWCL patients aged below 65 years and without co-morbidities can be safely and effectively treated without hospital admission. This reduces the cost of treatment, and is much preferred by patients. Twice weekly blood and electrocardiographic monitoring may be surplus to requirement in clinically well, low-risk patients.
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Systematic review of the adverse effects of cutaneous leishmaniasis treatment in the New World. Acta Trop 2011; 118:87-96. [PMID: 21420925 DOI: 10.1016/j.actatropica.2011.02.007] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 02/07/2011] [Accepted: 02/12/2011] [Indexed: 11/22/2022]
Abstract
Pentavalent antimonials are first-line drugs for the treatment of the cutaneous form of American tegumentary leishmaniasis. Second-line drugs include amphotericin B and pentamidine. Although these drugs have been used for decades, there are no systematic reviews about their safety. The objective of this review was to identify and classify the main adverse effects associated with these drugs and to estimate the frequency of these effects, whenever possible. Intervention studies, case series and case reports containing information regarding clinical, laboratory or electrocardiographic adverse effects of drugs used for the treatment of cutaneous leishmaniasis were systematically retrieved from 10 databases searched between August 13, 2008 and March 31, 2009. The 65 studies included in this review had treated a total of 4359 patients from 12 countries infected with eight different Leishmania species. Despite the small number of drugs used in these studies, a wide variability in the therapeutic regimens was observed. As a consequence, the adverse effects of pentavalent antimonials and pentamidine needed to be classified jointly according to system, irrespective of formulation, daily dose, duration of treatment, and route of administration. The frequencies of adverse effects were calculated based on the data of 32 articles involving 1866 patients. The most frequently reported clinical adverse effects of pentavalent antimonials and pentamidine were musculoskeletal pain, gastrointestinal disturbances, and mild to moderate headache. Electrocardiographic QTc interval prolongation and a mild to moderate increase in liver and pancreatic enzymes were additional adverse effects of pentavalent antimonials. Patients treated with liposomal amphotericin B had mild dyspnea and erythema. The adverse effects associated with miltefosine were vomiting, nausea, kinetosis, headache, diarrhea, and a mild to moderate increase in aminotransferases and creatinine. Although closer surveillance is needed for the treatment of cutaneous leishmaniasis, antileishmanial drugs are basically safe and severe side effects requiring the discontinuation of treatment are relatively uncommon.
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Wortmann G, Zapor M, Ressner R, Fraser S, Hartzell J, Pierson J, Weintrob A, Magill A. Lipsosomal amphotericin B for treatment of cutaneous leishmaniasis. Am J Trop Med Hyg 2010; 83:1028-33. [PMID: 21036832 DOI: 10.4269/ajtmh.2010.10-0171] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Treatment options for cutaneous leishmaniasis in the United States are problematic because the available products are either investigational, toxic, and/or of questionable effectiveness. A retrospective review of patients receiving liposomal amphotericin B through the Walter Reed Army Medical Center for the treatment of cutaneous leishmaniasis during 2007-2009 was conducted. Twenty patients who acquired disease in five countries and with five different strains of Leishmania were treated, of whom 19 received a full course of treatment. Sixteen (84%) of 19 experienced a cure with the initial treatment regimen. Three patients did not fully heal after an initial treatment course, but were cured with additional dosing. Acute infusion-related reactions occurred in 25% and mild renal toxicity occurred in 45% of patients. Although the optimum dosing regimen is undefined and the cost and toxicity may limit widespread use, liposomal amphotericin B is a viable treatment alternative for cutaneous leishmaniasis.
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Affiliation(s)
- Glenn Wortmann
- Infectious Diseases Service, Walter Reed Army Medical Center, Washington, District of Columbia 20307, USA.
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Affiliation(s)
- Johannes A Blum
- Medical Department, Swiss Tropical Institute, Basel, Switzerland.
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Abstract
Infection with protozoan parasites of the genus Leishmania leads to a wide variety of clinical disease syndromes called leishmaniasis, or more appropriately the leishmaniases. The three major clinical syndromes are cutaneous leishmaniasis, mucosal leishmaniasis, and visceral leishmaniasis. All three of these syndromes have been documented in returning travelers. This article focuses on cutaneous leishmaniasis with some comment on mucosal leishmaniasis.
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Affiliation(s)
- Alan J Magill
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
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Abstract
Leishmaniasis occurs not only in American travelers and military personnel alike but infects a significant portion of the world's population. The US military has made major contributions to the understanding of the complicated epidemiology of this parasite, the development of rapid reliable diagnostic tests, and to the development of safe, more efficient, and more effective treatment of leishmaniasis.
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Affiliation(s)
- J R Kenner
- Dermatology Service, Walter Reed Army Medical Center, Washington, DC, USA
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