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de Oliveira Duque MC, Quintão Silva JJ, Soares PAO, Magalhães RS, Horta APA, Paes LRB, Rosandiski Lyra M, Pimentel MIF, de Fátima Antonio L, de Camargo Ferreira e Vasconcellos É, Saheki MN, de Almeida Marzochi MC, Valete-Rosalino CM, de Oliveira Schubach A. Comparison between systemic and intralesional meglumine antimoniate therapy in a primary health care unit. Acta Trop 2019; 193:176-182. [PMID: 30851256 DOI: 10.1016/j.actatropica.2019.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/27/2022]
Abstract
Cutaneous leishmaniasis (CL) is not a life-threatening condition. However, its treatment can cause serious adverse effects and may sometimes lead to death. Recently, safer local treatments have been included among therapies acceptable to New World CL cases, but the use of intralesional meglumine antimoniate (IL-MA) is recommended to be performed in reference centers, for patients with single cutaneous lesions <3 cm in diameter at any location except the head and periarticular regions; the volume of injected MA should not exceed 5 mL. In this study we compared two groups of patients with CL treated with MA in a primary health care unit in Brazil. Patients were treated with systemic MA (n = 76) or IL-MA (n = 30). In the IL-MA group, 93% of patients had one or more of the following lesion characteristics: two or more lesions, lesions >3 cm in diameter, lesions located in the head or in periarticular regions, or had been administered IL-MA volumes >5 mL. Patients responded well (68.4% and 66.7% for the MA and IL-MA groups, respectively). When a second cycle of treatment was necessary, the responses were 72.4% and 90%, respectively. There were no significant differences between groups. In the IL-MA group, 43% had mild to moderate adverse effects, without needing treatment discontinuation. Results suggest that the treatment of CL lesions with IL-MA is simple, efficient, and safe.
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Soto J, Paz D, Rivero D, Soto P, Quispe J, Toledo J, Berman J. Intralesional Pentamidine: A Novel Therapy for Single Lesions of Bolivian Cutaneous Leishmaniasis. Am J Trop Med Hyg 2016; 94:852-6. [PMID: 26903605 DOI: 10.4269/ajtmh.15-0640] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/21/2015] [Indexed: 11/07/2022] Open
Abstract
A novel therapy, intralesional (IL) pentamidine, was compared to intralesional therapy with antimony (ILSb), a World Health Organization-recommended therapy, for single Bolivian Leishmania braziliensis lesions. In Study 1, 90 patients were randomized equally between three injections of ILSb over 5 days, five injections of ILSb over 11 days, and three injections of IL pentamidine (120 μg/mm(2)lesion area [ILPenta-120-3]) over 5 days. Cure rates at 6 months were 57% for ILSb-3 injections, 73% for ILSb-5 injections, and 72% for ILPenta-120-3 injections. Adverse effects were local irritation and injection-site pain-ILSb (60 patients): mild (25), moderate (4); IL pentamidine (30 patients): mild (4), moderate (3). In Study 2, 60 patients were randomized equally between five injections of ILSb and three injections of a double dose of IL pentamidine (240 μg/mm(2)[ILPenta-240-3]). In Study 2, cure rates were 67% for ILSb-5 injections and 73% for ILPenta-240-3. For three IL injections of pentamidine, efficacy was optimized at a dose of 120 μg/mm(2)lesion area. The cure rate of that regimen was similar to that for ILSb-5 injections and nonstatistically larger than that of ILSb-3 injections. IL pentamidine is an attractive alternative to ILSb on the basis of efficacy for Bolivian L. braziliensis, the threat of Sb-resistant parasites, tolerance, and patient convenience of three visits over 5 days.
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Affiliation(s)
- Jaime Soto
- Fundación Nacional de Dermatología (FUNDERMA), Santa Cruz, Bolivia; Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia; Hospital Local, Palos Blancos, Bolivia; Centro de Investigaciones Bioclínicas de la Fundación Fader (FADER-CIBIC), Bogota, Colombia; AB Foundation, North Bethesda, Maryland
| | - David Paz
- Fundación Nacional de Dermatología (FUNDERMA), Santa Cruz, Bolivia; Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia; Hospital Local, Palos Blancos, Bolivia; Centro de Investigaciones Bioclínicas de la Fundación Fader (FADER-CIBIC), Bogota, Colombia; AB Foundation, North Bethesda, Maryland
| | - Daniela Rivero
- Fundación Nacional de Dermatología (FUNDERMA), Santa Cruz, Bolivia; Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia; Hospital Local, Palos Blancos, Bolivia; Centro de Investigaciones Bioclínicas de la Fundación Fader (FADER-CIBIC), Bogota, Colombia; AB Foundation, North Bethesda, Maryland
| | - Paula Soto
- Fundación Nacional de Dermatología (FUNDERMA), Santa Cruz, Bolivia; Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia; Hospital Local, Palos Blancos, Bolivia; Centro de Investigaciones Bioclínicas de la Fundación Fader (FADER-CIBIC), Bogota, Colombia; AB Foundation, North Bethesda, Maryland
| | - Jorge Quispe
- Fundación Nacional de Dermatología (FUNDERMA), Santa Cruz, Bolivia; Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia; Hospital Local, Palos Blancos, Bolivia; Centro de Investigaciones Bioclínicas de la Fundación Fader (FADER-CIBIC), Bogota, Colombia; AB Foundation, North Bethesda, Maryland
| | - Julia Toledo
- Fundación Nacional de Dermatología (FUNDERMA), Santa Cruz, Bolivia; Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia; Hospital Local, Palos Blancos, Bolivia; Centro de Investigaciones Bioclínicas de la Fundación Fader (FADER-CIBIC), Bogota, Colombia; AB Foundation, North Bethesda, Maryland
| | - Jonathan Berman
- Fundación Nacional de Dermatología (FUNDERMA), Santa Cruz, Bolivia; Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia; Hospital Local, Palos Blancos, Bolivia; Centro de Investigaciones Bioclínicas de la Fundación Fader (FADER-CIBIC), Bogota, Colombia; AB Foundation, North Bethesda, Maryland
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Norman FF, Monge-Maillo B, Martínez-Pérez Á, Perez-Molina JA, López-Vélez R. Parasitic infections in travelers and immigrants: part I protozoa. Future Microbiol 2015; 10:69-86. [DOI: 10.2217/fmb.14.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT The growth in international commerce, travel and migration contribute to the global emergence of certain parasitic infections. Importation of vectors and food products may contribute to the emergence of protozoan infections in nonendemic countries. Infections such as malaria are potentially fatal, especially in nonimmune patients, and outcome depends largely on timely diagnosis and treatment. Diagnosis/management of imported parasitic infections may be complex especially as some patients may have underlying immunosuppressive conditions such as HIV infection. Major challenges concern the development of improved diagnostic techniques, safer/more effective drug therapies and identification of biological markers of progression and response to treatment. Imported parasitic diseases which may be transmitted vertically or through blood transfusion/organ donation could become a public health priority in the near future. Climate change may affect arthropod distribution and facilitate the spread of protozoan vector-borne diseases. The first part of this review focuses on protozoan infections in travelers and immigrants.
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Affiliation(s)
- Francesca F Norman
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Begoña Monge-Maillo
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Ángela Martínez-Pérez
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Jose A Perez-Molina
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Rogelio López-Vélez
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
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