Óbito durante tratamento da leishmaniose tegumentar americana com stibogluconato de sódio bp 88® (shandong xinhua)

Abstract

The authors report the occurrence of a fatal case in patient with cutaneous leishmaniasis in the municipality of Caxias, MA. Male patient, 22 years old, road sweeper, presented with an ulcer in left leg, diagnosed as cutaneous leishmaniasis and treated with sodium stibogluconate BP88 (Sb+5) (Shandong Xinhua) at a dose of 10mg/Sb+5/kg/day/20 days. After dose three he presented arthralgia, myalgia, nausea and weakness. During the therapy there was an aggravation of the symptoms with abdominal pain and irradiation into the thorax. After dose seven he presented a picture of associated dyspnea and thoracic pain of mild intensity. At dose nine there was further worsening of the picture, nevertheless the therapy was continued up to dose 11, when the patient's state deteriorated to such an extent that he was hospitalized in the intensive care unit. Exams: erythrocytes, 4.4 million; hemoglobin, 10.6%; hematocrits, 35%; white blood cells 26,400, basophiles and myelocytes (0); segmented leukocytes, 59%; lymphocytes 30%; monocytes 2%; platelets (normal); glucose, 42mg%; urea, 73mg%; creatinine, 2.4mg%; and ECG (blockade of right branch). The patient died from cardiorespiratory insufficiency. The current report underscores the need to clarify health workers regarding the use of Sb+5 and also to remind the Health Ministry to verify the quality and origin when acquiring new products.

Miltefosina oral para el tratamiento de la leishmaniasis

“…Miltefosine, originally an antineoplastic drug, has a potent leishmanicidal activity as consequence of its interference in parasite metabolic pathways and the induction of apoptosis, has demonstrated efficacy against L. donovani visceral En la década de 1940 se inició el empleo de los antimoniales pentavalentes para el tratamiento de las diversas formas clínicas de leishmaniasis. Desde hace quince años se vienen reportando fallas terapéuticas en algunas regiones de India, Sudán y Etiopía (1,2), razón por la cual se han hecho ajustes en las dosis diarias y en el tiempo de administración con lo que se ha logrado mantener su eficacia pero con el inconveniente del incremento en la frecuencia y seriedad de los efectos secundarios (3,4). En Colombia se reportó recientemente (5) que los antimoniales pentavalentes continúan siendo efectivos en más del 90% de los casos cuando se emplean en la dosis y por el tiempo recomendado pero que su actividad declina hasta 50% cuando se hacen pausas, se acorta el tiempo de administración o se emplean dosis menores, circunstancias éstas frecuentemente secundarias a la presencia de eventos adversos.…”