Acessibilidade / Reportar erro

Eficácia do sulfato de aminosidine na leishmaniose visceral grave, resistente ao tratamento com antimonial pentavalente

Resumos

Descreve-se um caso de calazar grave resistente a dez cursos de antimonial petitavalente (glucantime) à base de 20mg de Sb5/kg/dia, que respondeu favoravelmente ao sulfato de aminosidine intramuscular na dose de 20mg/kg/dia por 20 dias, repetido após 20 dias. O parasitismo esplénico passou de 50 parasitos por campo a 3 parasitos em 10 campos logo após a primeira série de sulfato de aminosidine, tornando-se negativo depois de sete meses. A melhora clínica foi imediata, com redução gradual da hepatoesplenomegalia, e desaparecimento 26 meses após. Neste período aumentou 13 kg. Após o uso de aminosidine a reação de Monténégro tornou-se positiva e as células mononucleares responderam quando estimuladas com antígenos de leishmânia.

Aminosidine no calazar; Calazar resistente ao glucantime; Calazar grave


A grave kala-azar infection in a 14 years old boy is described. The leishmanial infection failed to respond to ten interrupted courses of glucantime of variable duration (14-56 days) at a dose of 20mg Sb5/kg/day. However a favorable response ocurred to intramuscular aminosidine sulphate (20mg/kg/day) for 20 days. This same regimen was repeated 20 days later. After the first treatment splenic puncture parasite density fell from 50 amastigotes per oil immersion field to 3 amastigotes in 10 fields. A further splenic puncture 7 months after treatment was negative. The marked hepatoesplenomegaly gradually resolved over 26 months follow up and he gained 13 kilogramas in weight. After aminosidine sulphate therapy his Montenegro reaction become positive and his lymphocytes responded to leishmania antigens.

Aminosidine in kala-azar therapy; Kala-azar unresponsive to glucantime; Severe kala-azar


RELATO DE CASO

Eficácia do sulfato de aminosidine na leishmaniose visceral grave, resistente ao tratamento com antimonial pentavalente

Cleudson Castro; Vanize Macêdo; Mário L. Silva-Vergara; Cesar Cuba; Celeste A. Silveira; Edgar Carvalho; Philip Marsden

Endereço para correspondência Endereço para correspondência: Prof. Cleudson Castro. Núcleo de Medicina Tropical e Nutrição UnB, Caixa Postal 04671 Brasília, DF Brasil

RESUMO

Descreve-se um caso de calazar grave resistente a dez cursos de antimonial petitavalente (glucantime) à base de 20mg de Sb5/kg/dia, que respondeu favoravelmente ao sulfato de aminosidine intramuscular na dose de 20mg/kg/dia por 20 dias, repetido após 20 dias. O parasitismo esplénico passou de 50 parasitos por campo a 3 parasitos em 10 campos logo após a primeira série de sulfato de aminosidine, tornando-se negativo depois de sete meses. A melhora clínica foi imediata, com redução gradual da hepatoesplenomegalia, e desaparecimento 26 meses após. Neste período aumentou 13 kg. Após o uso de aminosidine a reação de Monténégro tornou-se positiva e as células mononucleares responderam quando estimuladas com antígenos de leishmânia.

Palavras-chave: Aminosidine no calazar. Calazar resistente ao glucantime. Calazar grave.

ABSTRACT

A grave kala-azar infection in a 14 years old boy is described. The leishmanial infection failed to respond to ten interrupted courses of glucantime of variable duration (14-56 days) at a dose of 20mg Sb5/kg/day. However a favorable response ocurred to intramuscular aminosidine sulphate (20mg/kg/day) for 20 days. This same regimen was repeated 20 days later. After the first treatment splenic puncture parasite density fell from 50 amastigotes per oil immersion field to 3 amastigotes in 10 fields. A further splenic puncture 7 months after treatment was negative. The marked hepatoesplenomegaly gradually resolved over 26 months follow up and he gained 13 kilogramas in weight. After aminosidine sulphate therapy his Montenegro reaction become positive and his lymphocytes responded to leishmania antigens.

Keywords: Aminosidine in kala-azar therapy. Kala-azar unresponsive to glucantime. Severe kala-azar.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido para publicação em 11/08/94.

Núcleo de Medicina Tropical e Nutrição, Hospital da Universidade de Brasília DF e Hospital Prof. Edgard Santos, Salvador, Ba. UFBa

  • 1. Badaró R, Falcoff E, Badaró FS, Carvalho EM, Pedral-Sampaio D, Barrai A, Carvalho JS, Barral-Neto M, Brandley M, Silva L, Bina JC, Teixeira R, Falcoff R, Rocha H, Ho JL, Johnson Jr WJ. Treatment of Visceral Leishmaniasis with pantavalent antimony and interferon gamma. The New England Journal of Medicine 322:16-21, 1990
  • 2. Bryceson ADM, Chulay JD, May HO, Mugambu M, Were JB, Muigai R, Chunge C, Gachihi G, Meme J, Anabwani G, Bhatt SM. Visceral leishmaniasis unresponsive to antimonial drugs I. Clinical and immunological studies. Transactions of the Royal Society ofTropical Medicine and Hygiene 79:700- 704,1985.
  • 3. Carvalho EM, Teixeira RS, Johnson WDJr. Cell mediated immunity in American visceral leishmaniasis: reversible immunosupression during acute infection. Infection and Immunity 33:498-503,1981.
  • 4. Castro C, Macêdo V, Vergara ML, Cuba C, Silveira CA, Marsden E Leishmaniose visceral resistente, respondendo ao tratamento com Aminosidine. Revista da Sociedade Brasileira de Medicina Tropical 25 (Supl):85,1992.
  • 5. Castro C, Macêdo V, Vergara ML, Cuba-C, Silveira CA, Marsden P, Carvalho E. "Follow-up" de paciente com Calazar resistente ao tratamento com Antimonial Pentavalente e curado com Aminosidine. In: Resumos do XXIX Congresso da Sociedade Brasileira de Medicina Tropical, Fortaleza p 228,1993.
  • 6. Chulay JD, Bryceson ADM. Quantitation of amastigotas of Leishmania donovani in smears of splenic aspirates from patients with visceral leishmaniosis. American Journal of Tropical Medicine and Hygiene 32:475-479,1983.
  • 7. Chunge CN, Gachihi G, Muigai R, Wasuna K, Rashid JR, Chulay JD, Anabwani G, Oster CN, Bryceson ADM. Visceral leishmaniasis unresponsive to antimonial drugs. Ill Sucessful treatment using a combination of sodium stibogluconate plus allopurinal. Transactions of the Royal Society of Tropical Medicine and Hygiene 79:715,1985.
  • 8. Chunge CN, Owate J, Pamba HO, Donno L. Treatment of visceral leishmaniasis in Kenya by aminosidine alone or combined with sodium stibogluconate. Transaction of the Royal Society of Tropical Medicine and Hygiene 84:221-225, 1990.
  • 9. Dietze R, Araujo RC, Lima MLR, Yexenet JA, Marsden PD, Barreto AC. Ensaio terapêutico com glucantime em Saguis (Callithrix jacchus) infectados com uma cepa de Leishmania donovani aparentemente resistente ao tratamento. Revista da Sociedade Brasileira de Medicina Tropical 18:39-42,1985.
  • 10. Dietze R, Milan EP, Berman JD, Grogi M, Falqueto A, FeitosaTF, Luz KG, Suassuna FAB, Marinho LAC, Ksionski G. Treatment of brasilian Kala-Azar with a short course of Amphocil (Amphotericin B Cholesterol Dispersion). Clinical Infectious Diseases 17:981-986,1993.
  • 11. Grogl M,ThomasonT, Franke E. Drug resistence in Leishmaniasis; its implication in systemic chemotherapy of cutaneous and mucocutaneous disease, American Journal of Tropical Medicine and Hygiene 47:117-126,1992.
  • 12. Marsden PD. Letter to the Editor "Evaluation of three chemotherapeutic schemes with Meglumine Antimoniate in the treatment of visceral leishmaniasis in the state of Pará, Brazil". Revista do Instituto de Medicina Tropical de Sào Paulo 35:589,1993.
  • 13. Olliaro PL, Bryceson ADM. Practical progress and new drugs for changing patterns of leishmaniosis. Parasitology today 9:323-328,1993.
  • 14. Scott JAG, Davidson RN, Moody AH, Grant HR, Felmingham D, Scott GMS, Olliaro P. Aminosidine (paromomicyn) in the treatment of leishmaniasis imported into the United Kingdom. Transaction of the Royal Society of Tropical Medicine and Hygiene 86:617-619,1992.
  • 15. Sundar S, Thakur BB, Tandon AK, Agrawal NR, Mishra CP, Mahapatra TM, Singh VP. Clinico epidemiological study of drug resistence in indian kalaazar. British Medical Journal 308:307,1994.
  • 16. World Health Organization. Report of the informal meeting on the chemotherapy of visceral leishmaniasis. TDR/Chemleish/VL/82,3. World Health Organization, Geneva 1982.
  • 17. World Health Organization. Antimonials: large- scale failure in leishmaniasis "alarming". TDR News, Geneva n° 34:1 e 7,1990.
  • Endereço para correspondência:

    Prof. Cleudson Castro.
    Núcleo de Medicina Tropical e Nutrição UnB,
    Caixa Postal 04671
    Brasília, DF Brasil
  • Datas de Publicação

    • Publicação nesta coleção
      09 Abr 2013
    • Data do Fascículo
      Set 1995

    Histórico

    • Aceito
      11 Ago 1994
    • Recebido
      11 Ago 1994
    Sociedade Brasileira de Medicina Tropical - SBMT Caixa Postal 118, 38001-970 Uberaba MG Brazil, Tel.: +55 34 3318-5255 / +55 34 3318-5636/ +55 34 3318-5287, http://rsbmt.org.br/ - Uberaba - MG - Brazil
    E-mail: rsbmt@uftm.edu.br