Resolução de leishmaniose cutânea após eczema agudo devido a antimoniato de meglumina intralesional

Relatamos caso de paciente de 42 anos atendida em centro de referência em leishmanioses no Rio de Janeiro, Brasil, apresentando lesão de leishmaniose cutânea no antebraço direito. Iniciado tratamento com baixa dose de antimoniato de meglumina (AM) intramuscular (5 mg Sb5+/kg/dia), houve melhora após 28 dias, porém com desenvolvimento de eczema generalizado. Após 87 dias, notou-se piora da lesão. A paciente recusou o tratamento com anfotericina B. Infiltrou-se AM na lesão em duas sessões, resultando em eczema local com bolhas. Entretanto, 20 dias depois, tanto a úlcera quanto o eczema regrediram. A administração intralesional do AM deve ser utilizada com cautela em pacientes com hipersensibilidade cutânea a este fármaco.We report a case of a 42 year-old female, who came to a leishmaniasis reference center in Rio de Janeiro, Brazil, presenting a cutaneous leishmaniasis lesion in the right forearm. Treatment with low-dose intramuscular meglumine antimoniate (MA) (5 mg Sb5+/kg/day) was initiated, with improvement after 28 days, although with the development of generalized eczema. After 87 days, the lesion worsened. Patient refused treatment with amphotericin B. MA was then infiltrated in the lesion, in two sessions, resulting in local eczema, with bullae formation; however, twenty days after, both the ulcer and eczema receded. Intralesional administration of MA should be used carefully when previous cutaneous hypersensitivity is detected

Fatores associados à adesão a diferentes esquemas de tratamento com antimoniato de meglumina em ensaio clínico para leishmaniose cutânea

O desfecho favorável ao tratamento de uma enfermidade é influenciado pela adesão à terapia. Objetivamos avaliar fatores associados à adesão ao tratamento dos pacientes incluídos em ensaio clínico de equivalência entre o esquema de tratamento padrão e alternativos com antimoniato de meglumina (AM) no tratamento da leishmaniose cutânea (LC) no estado do Rio de Janeiro. Entre 2008 e 2011, 57 pacientes com LC foram entrevistados através de questionário para coleta de dados socioeconômicos. Para monitorização da adesão foram utilizados os seguintes métodos: contagem de ampolas excedentes, cartão de acompanhamento, teste de Morisky e teste de Morisky modificado (sem a pergunta referente ao horário). Observou-se adesão de 82,1% (devolução de ampolas), 86,0% (cartão de acompanhamento), 66,7% (teste de Morisky) e 86,0% (teste de Morisky modificado). Houve forte concordância entre o método contagem de ampolas e cartão de acompanhamento, bem como teste de Morisky modificado. Verificou-se associação significativa entre maior adesão ao tratamento e baixa dose de AM, bem como com menor número de pessoas dormindo no mesmo quarto. Recomendamos a utilização do teste de Morisky modificado na avaliação da adesão ao tratamento da LC com AM por ser método simples e com bom desempenho quando comparado aos outros testes.The favorable outcome of the treatment of a disease is influenced by the adherence to therapy. Our objective was to assess factors associated with adherence to treatment of patients included in a clinical trial of equivalence between the standard and alternative treatment schemes with meglumine antimoniate (MA) in the treatment of cutaneous leishmaniasis (CL), in the state of Rio de Janeiro. Between 2008 and 2011, 57 patients with CL were interviewed using a questionnaire to collect socioeconomic data. The following methods were used for adherence monitoring: counting of vial surplus, monitoring card, Morisky test and modified Morisky test (without the question regarding the schedule); we observed 82.1% (vial return), 86.0% (monitoring card), 66.7% (Morisky test) and 86.0% (modified Morisky test) adherence. There was a strong correlation between the method of vial counting and the monitoring card and modified Morisky test. A significant association was observed between greater adherence to treatment and low dose of MA, as well as with a lower number of people sleeping in the same room. We recommend the use of the modified Morisky test to assess adherence to treatment of CL with MA, because it is a simple method and with a good performance, when compared to other methods

Two women presenting worsening cutaneous ulcers during pregnancy: diagnosis, immune response, and follow-up

Submitted by Rodrigo Senorans ([email protected]) on 2015-05-29T16:31:59Z No. of bitstreams: 1 Two women presenting worsening cutaneous ulcers during pregnancy diagnosis, immune response and follow u. p.pdf: 10352851 bytes, checksum: 3005e775edc20be8d47d6c7a9ec33a4a (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-05-29T17:58:17Z (GMT) No. of bitstreams: 1 Two women presenting worsening cutaneous ulcers during pregnancy diagnosis, immune response and follow u. p.pdf: 10352851 bytes, checksum: 3005e775edc20be8d47d6c7a9ec33a4a (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-05-29T17:59:09Z (GMT) No. of bitstreams: 1 Two women presenting worsening cutaneous ulcers during pregnancy diagnosis, immune response and follow u. p.pdf: 10352851 bytes, checksum: 3005e775edc20be8d47d6c7a9ec33a4a (MD5)Made available in DSpace on 2015-06-01T15:30:29Z (GMT). No. of bitstreams: 1 Two women presenting worsening cutaneous ulcers during pregnancy diagnosis, immune response and follow u. p.pdf: 10352851 bytes, checksum: 3005e775edc20be8d47d6c7a9ec33a4a (MD5) Previous issue date: 2013INI, IOC,CNPq, FAPERJ, FUNASA/MS, The Royal Society and The Wellcome TrustFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Vigilância em Leishmanioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Vigilância em Leishmanioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Vigilância em Leishmanioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Vigilância em Leishmanioses. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Departamento de Otorrino e Oftalmologia. Faculdade de Medicina. Rio de Janeiro, RJ, Brasil.Imperial College London. Faculty of Medicine. Section of Immunology. London, UK.Imperial College London. Faculty of Medicine. Section of Immunology. London, UK

(Upper panel) Parasite enumeration during pregnancy and postpartum.

<p>Amastigotes present in the lesions were enumerated by in situ immunohistochemistry in active cutaneous lesions of both pregnant patients (PP1, PP2) before treatment, in the eighth month of pregnancy (gray bars) and 2–6 months after birth (black bars). Amastigote numbers present in lesions of nonpregnant ATL patients (average of three patients) before treatment are shown as comparison. The results are expressed as number of parasites per mm², using a grid-scale consisting of 20×20 subdivisions in an area of 10 mm²×10 mm², adapted to slides as previously described <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002472#pntd.0002472-Morgado2" target="_blank">[24]</a>. The results shown are median ± SEM. n.d. = not detectable; (Lower panel) Serum arginase activity. Arginase activity (U/mL) was determined in sera obtained from peripheral blood of pregnant ATL patients collected at 3, 5, and 9 months of pregnancy (black bar PP1; grey bar PP2) as well as four age-matched nonpregnant ATL patients (hatched bars). The results shown are median ± SEM.</p

Determination of IFN-γ and IL-10–producing cells in the peripheral blood during pregnancy and postpartum.

<p>(A) The number of IFN-γ and (B) of IL-10–producing cells in peripheral blood was determined at 8 months of pregnancy and 2–6 months after birth in both pregnant ATL patients by ELISPOT assay and compared to those present in nonpregnant ATL patients before specific treatment and in healthy volunteers. Spontaneous release (black bars) as well as antigen-specific responses to restimulation with <i>Leishmania</i>-antigen in vitro (grey bars) are shown. The results from antigen-stimulated PBMC were expressed as the difference of the number of spots/10,000 PBMC in the antigen-stimulated wells minus the mean number of spots in control wells (with medium alone = spontaneous release) from the same donor. The results shown are median ± SEM.</p

Inflammatory reaction in active cutaneous lesions of untreated ATL patient (PP1) during pregnancy and postpartum.

<p>The inflammatory response in the lesions was assessed by in situ immunohistochemistry. (A,B) CD8⁺ cells, (C,D) CD68⁺ cells, (E,F) NOS2, (G,H) IFN-γ, and (I,J) IL-10 expression in active lesions of pregnant ATL patient (PP1). (A,C,E,G,I) at 8 months of pregnancy; (B,D,F,H,J) at 2–6 months post delivery; Magnification: 200× (bar = 50 µm); arrows indicate examples of positive areas.</p