Evaluation of miltefosine for the treatment of dogs naturally infected with L. infantum (=L. chagasi) in Brazil

Dogs naturally infected with Leishmania Infantum (=L. chagasi) were treated with miltefosine using different therapeutic regimens. The animals were evaluated for clinical evolution, biochemical parameters, parasite load (by real-time PCR), cytokine levels and humoral response. After treatment and during the following 24 months, there was progressive clinical improvement and complete recovery in 50% (7/14) of the treated animals. There was a decrease in the smear positivity of the bone marrow after treatment, and there was also a gradual and constant decrease in positive cultures at the end of the follow-up period. However, the PCR detection of parasite DNA remained positive. In general, all animals presented a significant increase in parasite load 6 months after treatment. The IFN-γ levels in all the groups tended to increase during follow-up period, regardless of the miltefosine dose administered. The IL-4 and IL-10 levels of the animals tended to decrease during follow-up, except after 300 days when only IL-10 increased. The serum antibodies identified antigens that ranged from 116 kDa to less than 29 kDa in the Western blot assay. Furthermore, 300 days after treatment, qualitative and quantitative differences in the antigen profiles were observed. Antigens of 97 and 46 kDa were the most intensely recognized. Higher levels of antigen-specific Leishmania IgG were detected before and 300 days after treatment in all groups. Taking together, the improvement in the clinical symptoms was not followed by parasitological clearance, suggesting that treatment with miltefosine is not recommended, especially in endemic areas like Brazil, where children are the major victims and dogs are involved in the maintenance of the parasite cycle.

Eight-year trend of new patients at Clinic for Disabled Patients, University Hospital, Faculty of Dentistry, Tokyo Medical and Dental University

The trend of new patients was investigated at the Clinic for Disabled Patients, University Hospital, Faculty of Dentistry, Tokyo Medical and Dental University for eight years from 1989 to 1996. The purpose of this study was to explore the future role of this specialized clinic. The study revealed the following information: 1. A total of 1,388 new patients, corresponding to 173.5 new patients per year on average, visited the clinic. 2. The percentage of patients aged 30 or more increased. As a result, the mean patient age rose from 40.4 in 1989 to 47.6 in 1996. 3. Referrals accounted for more than 80% of new patients. Medical doctors referred more patients to our clinic than dentists did. 4. While the percentage of disabled patients tended to decrease, the percentage of medically compromised patients increased. 5. The predominant complaint was dental caries. Patients with cardiovascular diseases also complained of gingival bleeding and ill-fitting dentures. The growing percentage of medically compromised patients and the increasing mean age of patients over the eight-year period seems to reflect advances in medical science and the aging society. These tendencies could be more remarkable in the future. Therefore, much closer cooperation between dentists and medical doctors will be required.