Mucosal leishmaniasis ("espundia") responsive to low dose of N-methyl glucamine (Glucantime ®) in Rio de Janeiro, Brazil

Abstract

Response to treatment with antimonial drugs varies considerably depending on the parasite strain involved, immune status of the patient and clinical form of the disease. Therapeutic regimens with this first line drug have been frequently modified both, in dose and duration of therapy. A regimen of 20 mg/kg/day of pentavalent antimony (Sb5+) during four weeks without an upper limit on the daily dose is currently recommended for mucosal disease ("espundia"). Side-effects with this dose are more marked in elderly patients, more commonly affected by this form of leishmaniasis. According to our experience, leishmaniasis in Rio de Janeiro responds well to antimony and, in cutaneous disease, high cure rates are obtained with 5 mg/kg/day of Sb5+ during 30 to 45-days. In this study a high rate of cure (91.4%) employing this dose was achieved in 36 patients with mild disease in this same geographic region. Side-effects were reduced and no antimony refractoriness was noted with subsequent use of larger dose in patients that failed to respond to initial schedule.

Endemic Tegumentary Leishmaniasis in Brazil: Correlation between Level of Endemicity and Number of Cases of Mucosal Disease

“…1,3,22,24,25 This estimate reinforces the idea of considering ML as secondary to the cutaneous form, even in cases where a skin lesion is not detected or is clinically manifested as self-limited. 2,3,21,22 Genetic studies have shown a large similarity between L. ( V. ) braziliensis isolates from the Amazon region and those from the South region of Brazil, 26 large genetic variability of this parasite in the Amazon region, and less variability in other regions of the country.…”

Epidemiological and clinical features of Leishmania (Viannia) braziliensis American cutaneous and mucocutaneous leishmaniasis in the State of Espírito Santo, Brazil

“…The key question for L. (V.) braziliensis in this respect is to establish the minimum dose of pentavalent antimonial that will cure the skin lesion rapidly and prevent mucosal relapse (Marsden 1985). ATL caused by this pathogen in Rio de Janeiro responds well to antimony and, in either cutaneous or mucosal disease, high cure rates were obtained with 5 mg/kg/day of glucantime® (Oliveira-Neto et al 2000). Conversely, we have also observed spontaneous healing in some patients who for various reasons have never taken specific treatment.…”

Leishmaniasis cutánea y herpes zoster multidermatómico

“…Las publicaciones de casos asociados con meglumina también son escasos. Oliveira Neto y cols., en una serie de pacientes con leishmaniasis mucosa que recibieron meglumina, reportaron dos pacientes que desarrollaron herpes zoster y tres pacientes con herpes simplex al finalizar la terapia 10 . En otra serie se registraron, en pacientes hospitalizados con herpes zoster, dos casos (3,8%) que habían recibido meglumina previamente 11 .…”