Amato, Valdir Sabbaga

Cieslinski, Juliette

Imamura, Rui

Santos, Carolina Rocio

Souza, Regina Maia de

Tuon, Felipe Francisco

English

Cadernos Espinosanos (E-Journal)

Rev Inst Med Trop São Paulo. 2018;60:e71 Page 1 of 2LETTER TO THE EDITORhttp://dx.doi.org/10.1590/S1678-9946201860071This is an open-access article distributed under the terms of the Creative Commons Attribution License.1Pontifícia Universidade Católica do Paraná, Escola de Medicina, Curitiba, Paraná, Brazil2Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil3Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia (LIM-46), São Paulo, São Paulo, Brazil4Universidade de São Paulo, Faculdade de Medicina, Departamento de Otorrinolaringologia, São Paulo, São Paulo, BrazilCorrespondence to: Felipe Francisco Tuon Pontifícia Universidade Católica do Paraná, Escola de Medicina, Rua Imaculada Conceição, 1155, CEP 80215-901, Curitiba, PR, Brazil Tel: +55 41 3271-1555E-mail: felipe.tuon@pucpr.brReceived: 22 October 2018Accepted: 23 October 2018Treatment of mucosal leishmaniasis with amphotericin B lipid complex (ABLC)Dear EditorMucosal leishmaniasis (ML) is a disease that can destroy cartilages, the pharynx and larynx, as well as bone structures of the face1. The treatment of ML is essentially based on the use of antimonial pentavalent. However, this drug has several adverse effects (AEs) and contraindications. Amphotericin B has been an alternative to antimonial pentavalent, mainly the liposomal formulation (L-AMB)2. However, the cost of the drug can be prohibitive to developing countries, and the ideal dose has not yet been established. Amphotericin B lipid complex (ABLC) is another lipid formulation of amphotericin B, with less nephrotoxicity than the deoxycholate formulation and is less expensive than L-AMB. As far as we know, this is the first report on a series of cases on the treatment of ML with ABLC. We report 13 cases of patients with ML treated with ABLC from a Brazilian cohort from January 2000 to July 2015. Patients with confirmed ML older than 18 years and followed-up for at least 6 months were included in the cohort. Patients without confirmation of ML and refusal of treatment were excluded. The diagnosis of ML included the amplification of Leishmania spp. DNA in tissue samples by molecular techniques, isolation of parasites in cultures, or the finding of typical structures during the histological examination or in immunohistochemistry tests. Otorhinolaryngological evaluations were performed in all patients. Pentavalent antimonial was the first option of treatment. Lipid formulations were indicated after pentavalent antimonial failure, appearance of side effects or the presence of a contraindication for the pentavalent antimonial use. The choice of the lipid formulation of amphotericin B was a medical decision and in 13 cases ABLC (1–4 mg/kg/day to achieve a cumulative dose of 1,500 to 2,500 mg) was administered. Cure, failure and recurrence episodes were previously defined3. AEs associated with the treatment of ML were analyzed during the hospitalization period. Acute kidney injury (AKI) was defined according to the AKIN criteria4. The median age of the patients was 58 [IQR 55-65] years old and 53.8% of patients were men. Most patients presented symptoms for more than 5 years (65.4%). All species identified were L. braziliensis. Treatment of all patients with ML was performed in the hospital with a median hospitalization time of 25 [IQR 19-28] days. ABLC was associated with several infusion-related AEs (Table 1). The cure rate of the group that used ABLC was 46.1%, and 1 case considered previously cured has recurred. The dosage of ABLC varied from 1 to 4.5 mg/kg (average 2.6 mg/kg). The mean cumulative dose was 1,253 mg (planned cumulative dose of 1,500 to 2,500 mg). Data on ABLC in the treatment of ML have not been published in the literature, although this drug has been used since the 1990s for the treatment of visceral leishmaniasis5. The results showed a success rate limited to 46.1% (6/13) and a relapse rate of 7.7%. Other drugs have shown clinical cure rates between 71.0% and 77.0% of the cases1. Recurrence with the use of antimonial pentavalent is around 22%1. However, the daily recommended dose was low, not achieving the adequate cumulative dose. The treatment of ML is still far from the ideal because the best performing drugs for this condition have numerous AEs, and drugs that Tuon et al.Rev Inst Med Trop São Paulo. 2018;60:e71Page 2 of 2are safer to use have lower efficacy. ABLC presented a low rate of cure and several side effects, suggesting that the use of this drug is questionable.Felipe Francisco Tuon1Carolina Rocio Santos2Juliette Cieslinski1 Regina Maia de Souza3Rui Imamura4Valdir Sabbaga Amato2AUTHORS’ CONTRIBUTIONSFelipe Francisco Tuon: wrote the manuscript; Carolina Rocio Santos: evaluated the cases; Juliette Cieslinski: reviewed the manuscript; Regina Maia de Souza: microbiological and others tests; Rui Imamura: follow up of patients and manuscript review; Valdir Sabbaga Amato: manuscript review.REFERENCES 1. Amato VS, Tuon FF, Bacha HA, Neto VA, Nicodemo AC. Mucosal leishmaniasis. Current scenario and prospects for treatment. Acta Trop. 2008;105:1-9. 2. Amato VS, Tuon FF, Camargo RA, Souza RM, Santos CR, Nicodemo AC. Can we use a lower dose of liposomal amphotericin B for the treatment of mucosal American leishmaniasis? Am J Trop Med Hyg. 2011;85:818-9. 3. Amato VS, Tuon FF, Imamura R, Abegão de Camargo R, Duarte MI, Neto VA. Mucosal leishmaniasis: description of case management approaches and analysis of risk factors for treatment failure in a cohort of 140 patients in Brazil. J Eur Acad Dermatol Venereol. 2009;23:1026-34. 4. Bagshaw SM, George C, Bellomo R. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008;23:1569-74. 5. Sundar S, Murray HW. Cure of antimony-unresponsive Indian visceral leishmaniasis with amphotericin B lipid complex. J Infect Dis. 1996;173:762-5.Table 1 - Clinical and laboratorial findings of 13 patients with mucosal leishmaniasis.N Sex Age Weight Site Previous treatmentInterruption due to side effectsPhebitis Infusion side effects AKICrCl* (mL/min)Electrolyte distur-banceMyelo-toxicityDosage (mg/kg/d) Cure1 M 52 93 Palate and pharynx No Yes YesSweat, nausea, chest painNo 77.2 No Yes 3.0 No2 F 72 63 Nasal septum No Yes Yes Chest pain No 35 Yes No 1.7 No3 M 58 95 Nasal septum Yes No YesFever, sweat, nauseaNo 108.2 Yes No 1.1 Yes4 F 55 64 Nasal septum Yes Yes No Chills No 42.8 No No 3.1 No5 M 64 72 Nasal septum Yes Yes NoNausea and vomits No 71.8 No No 2.8 No6 M 71 44Palate, pharynx and larynxNo No Yes  No 60.2 Yes No 4.5 Yes7 F 53 45 Nasal septum No Yes NoNausea and vomits No 54.4 Yes No 2.0 No8 F 53 45 Nasal septum No No YesNausea and vomits, chest painYes 79.5 Yes No 2.1 Yes9 M 57 74 Nasal septum Yes No No  No 62.7 No No 2.0 Yes10 F 61 58 Palate and pharynx Yes Yes No Fever No 23.8 No No 4.0 No11 F 65 49Palate, pharynx and larynxYes No No  No 51.6 No No 3.1 Yes12 M 57 74 Nasal septum Yes No No  No 43.3 Yes No 2.0 Yes13 Male 76 62Nasal septum and pharynxYes No Yes  No 52.3 No No 2.4 No*creatinine clearance

Treatment of mucosal leishmaniasis with amphotericin B lipid complex (ABLC)

https://www.revistas.usp.br/rimtsp/article/download/151717/148634

Treatment of mucosal leishmaniasis with amphotericin B lipid complex (ABLC)

Abstract

Similar works

Full text

Available Versions

Cadernos Espinosanos (E-Journal)