Tratamento da forma mucosa de leishmaniose sem resposta a glucantime, com anfotericina B liposomal

Abstract

A forma mucosa da LTA em nosso país é geralmente causada pela Leishmania (Viannia) braziliensis, L(V)b. Esta cepa se caracteriza por alta agressividade aos tecidos cutâneos mucosos, escassez e difícil isolamento dos parasitos nos tecidos e resistência ao tratamento por antimoniais, podendo ocorrer, freqüentes recidivas da doença. Cinco por cento dos pacientes com lesões mucosas evoluem para morte, por complicações 12 .As drogas usadas na segunda linha de tratamento são tóxicas, de baixa tolerância e podem apresentar resistência 14 16 17 . A anfotericina B liposomal (ABL) foi usada com sucesso no calazar resistente a tratamento 3 20 e também na leishmaniose dérmica pós-calazar no Sudão 7 . Nosso objetivo foi testar a tolerância e eficácia da ABL (ambisome) em pacientes com forma mucosa de leishmaniose sem resposta ao antimonial pentavalente (glucantime). 30(2):125-128, mar-abr, 1997. MATERIAL E MÉTODOS Revista da Sociedade Brasileira de Medicina Tropical

Essential oil from leaves of Lantana camara: a potential source of medicine against leishmaniasis

“…However, according to Sampaio & Marsden (1997) the association of liposomes with amphotericin B increases its tolerability by patients because this association interacts directly with the parasite ergosterol and reacts less with the cholesterol of the host. And it also enhances the ability of macrophage to phagocyte the parasite.…”

Mucosal leishmaniasis: the experience of a Brazilian referral center

“…In recent years, based on a few retrospective studies 6,14 , lipid formulations of amphotericin B have been considered as the most attractive treatment modalities for ML, due to better safety profile. In our experience, consistent with a previous systematic review 4 , liposomal amphotericin B was as efficacious as Sb v .…”

“…In Brazil, meglumine antimoniate is the drug of choice 5 , despite its recognized toxicity, especially in pancreatic, hepatic and cardiac systems. Clinical experience of ML treatment with lipid formulations of amphotericin B has been increasing in recent years, but it is still scarce, although a quite promising 6,7 . On the other hand, azole drugs have been also identified as a treatment option for Leishmania major and Leishmania mexicana 1 .…”

An update on pharmacotherapy for leishmaniasis

“…96 In MCL unresponsive to antimonials, L AmB at the dose of 2-3 mg/kg/day for a minimum of 20 days cured, 5 out of 6 patients at 26-38 months of follow up. 97 A recent retrospective study in 16 patients of MCL in the cumulative dose of 30 to 35 mg/kg L AmB had healing of lesions in 88% of patients. 98 Amphotericin B colloidal dispersion (ABCD) has also shown a cure rate of 100% in 5 patients of MCL with no recurrence during the follow-up period of 7-14 months.…”