Avaliação da eficácia e segurança da farmacoterapia da leishmaniose visceral

Pós-graduação em Doenças Tropicais - FMB

Challenges in the therapy of visceral leishmaniasis in Brazil: a public health perspective

Over 3,000 yearly cases of Visceral Leishmaniasis (VL) are reported in Brazil. Brazilian Public Health System provides universal free access to antileishmania therapeutic options: Meglumine Antimoniate, Amphotericin B deoxycholate, and Liposomal Amphotericin B. Even though Amphotericin formulations have been advised for severe disease, this recommendation is mostly based on the opinion of experts and on analogy with studies conducted in other countries. Presently, there are two ongoing multicenter clinical trials comparing the efficacy and safety of the available therapeutic options. Some other issues require further clarification, such as severity markers and the approach to VL/AIDS coinfection. Brazil is facing the challenge of providing access to diagnosis and adequate treatment, in order to avoid VL-related deaths.

Pitiose cutânea equina de localização atípica tratada topicamente com solução de anfotericina B e DMSO

Background: Cutaneous lesions by Pythium insidiosum infection are commonly observed in horses, especially in those living at flooded environments. Equine pythiosis is characterized by the development of tumoral masses that are frequently located at distal limbs, ventral abdomen, thorax, breast and face. The lesions are usually granulomatous, serosanguineous and ulcerated, most often destroyed by self-mutilation due to the intense pruritus. The proposed treatment includes surgical excision followed by antifungal drugs administration, which can be done systemically or topically. Amphotericin B and dimethyl sulfoxide (DMSO) in association has been successfully used for cutaneous pythiosis topical treatment due to the DMSO property to carry any substance through plasmatic membranes.Case: The present report concerns a 12-year-old mixed breed gelding presenting with self-mutilation of a tumoral mass located at the left flank. The owners reported that the horse had initially presented a small wound that had evolved to a 20-cm in diameter mass in 4 weeks. Tissue samples were collected, processed and stained by the Gomori's methenamine silver (GMS) method. The histopathological analysis revealed Pythium insidiosum hyphae in a granulomatous tissue, especially located at peripheral region, where kunkers were present. Surgical excision of the mass followed by cauterization was indicated as initial treatment, and due to financial reasons, the owners elected only the topical antifungal therapy to control the fungus infection after surgery. Flunixin meglumine was also administrated for five days aiming the control of pain and inflammation. The wound was cleaned with povidone-iodine solution and rinsed with a solution containing, 50 mg, of amphotericin B in 10 mL of sterile water and 10 mL of DMSO. This procedure was carried Out twice a day. The wound healed fast due to an excellent centripetal epithelialization. and the horse was discharged after 64 days showing only 5% of the initial wound area. The owner reported by telephone the complete healing and hair growth 10 days after discharge.Discussion: Despite the atypical location of the tumoral lesion described at the present report, the history and clinical manifestations, especially the intense pruritus, showed similarity with other characteristic reports of equine cutaneous pythiosis. The diagnosis was confirmed by the histopathological examination showing hyphae structures, as described to be evidences of the presence of Pythium insidiosum in the tissue. The surgical procedure was the first step to provide remission of clinical signs, and one day after surgery the pruritus desapeared. After excision of the granulomatous tissue and cauterization, daily topical administration of amphotericin B associated with DMSO was effective in destroying the infectious agent, as observed by the excellent epithelization. A pink granulation tissue grew up providing an ideal surface for epithelial migration and the healing process progressed quickly. Centripetal epithelialization reduced the wound area until 3% of the initial area in 64 days of treatment, when the remaining wound was found almost completely healed and covered with hair. At the present report, the horse presenting pythiosis was only topically treated. The recommended therapy using amphotericin B and DMSO solution was effective, economically viable and low risk, considering that the systemic antifungal therapy usually suggested is expensive and extremely nephrotoxic. The atypical location of the lesion on the left flank shows that any anatomical region can be affected by the fungus, since the conditions for its development were present.

How can micelle systems be rebuilt by a heating process?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Acompanhamento laboratorial da função renal de cães sadios tratados experimentalmente com doses terapêuticas de anfotericina B

O presente trabalho objetivou avaliar a função renal de dez cães adultos saudáveis submetidos à administração de doses terapêuticas do antifúngico anfotericina B, cuja utilização tem sido limitada pelo seu elevado potencial nefrotóxico, e avaliar o método laboratorial mais sensível e precoce de diagnóstico de lesão renal. Foram realizadas, diariamente, urinálise, excreção fracionada de sódio e potássio, dosagem sérica de creatinina e uréia e atividade urinária de gama-glutamiltransferase (GGT). Concluiu-se que a anfotericina B provoca lesões nos túbulos proximal e distal, induzindo acidose tubular renal do tipo I e Diabetes insipidus nefrogênico em cães. Avaliação da função renal, preferencialmente por dosagens de creatinina, uréia e potássio séricos, é recomendada antes de cada aplicação do fármaco. A densidade urinária foi o parâmetro mais precocemente alterado pela lesão renal. A GGT urinária não foi eficaz para o diagnóstico precoce de lesão induzida por anfotericina B.

Avaliação tardia da função renal em doentes com paracoccidioidomicose tratados com anfotericina B por meio da determinação do ritmo de filtração glomerular com EDTA Cr51

A late survey of the renal function was performed in eighteen patients with paracoccidioidomycosis treated with amphotericin B, according to the glomerular filtration rate (RFG). The method was compartment analysis by single injection using EDTA Cr51, determined by its 'half biological life' and dosages of blood urea nitrogen and creatinine. The patients were seventeen males and one female. They were from 22 to 76 years old. Ten of these patients received 2 g of amphotericin B and eight of them received 4 g. There were no expressive difference between the two groups, taking into account age, dose in mg/kg of weight/day, time of conclusion of the treatment, urea, creatinine, glomerular filtration was smaller than the normal, and average of the half biological life of the EDTA Cr51 was large than the normal. The achieved results permitted us to consider that the amphotericin B determines deficit of renal function. However, by the present study, it hasn't been possible to affirm if the modifications are definitive.

PREVENCAO DE TROMBOFLEBITES PELO USO DE HEPARINA EM PACIENTES TRATADOS COM ANFOTERICINA B

The authors studied the incidence of thrombophlebitis in 41 patients treated intravenously with amphotericin B. The patients were divided in two different group: Group 1: patients treated with amphotericin B and hydrocortisone with heparin (1000 UI); Group 2: patients treated with amphotericin B and hydrocortisone. The results showed 23.81% of incidence of thrombophlebitis in Group 1 and 90% in Group 2. Thrombophlebitis in Group 1 ranged from mild to moderate without any change during the drug therapy. In Group 2, the incidence was 66.67% and the thrombophlebitis were severe being necessary the withdrawn of the drugs in 35.0% of the cases. We concluded that heparin, in low doses, in association with amphotericin B, was an efficient drug preventing or reducing the development of thrombophlebitis.

Disseminated Amphotericin-Resistant Fusariosis in Acute Leukemia Patients: Report of Two Cases

Disseminated fusariosis has emerged as a significant, usually fatal infection in immunocompromised hosts despite antifungal treatment. We describe here two patients with acute leukemia who developed disseminated amphotericin-resistant fusariosis, and review of six studies of cases series in the literature. Two Fusarium solani strains were isolated from blood and skin cultures of one patient, and one strain from the blood culture of the second patient. Both patients died despite antifungal treatment. Strains were identified by sequencing of ITS1 and ITS4 regions. Random amplified polymorphic DNA analysis of the three F. solani isolates showed a low degree of similarity. Screening for Fusarium spp. contaminants within our facility was negative. Using the CLSI M-38-A2 broth dilution method and E tests®, we found that the MICs were low for voriconazole (0. 12 and 0. 5 mg/L, respectively), unexpectedly high for amphotericin B (≥8 and ≥32 μg/mL, respectively) and itraconazole (≥16 mg/ml). Patients with leukemia or persistent neutropenia should be assessed for disseminated fungal infections, including biopsy and skin cultures. Antifungal susceptibility tests are important due to the possibility of the strains being amphotericin resistant. Treatments must be aggressive, with high doses of antifungals or combined therapy. © 2012 Springer Science+Business Media Dordrecht.

Aspectos fundamentais no desenvolvimento de sistemas microemulsionados contendo anfotericina B para uso oftálmico

As occurs with a number of drugs, the bioavailability of amphotericin B (AmB) used to treat fungal infections by the ocular route remains a great challenge to research scientists. In fact, the poor bioavailability of AmB is due mainly to the corneal barrier, which leads to a precorneal loss and consequent decrease in the absorption of this drug into the intraocular tissues. The toxicity associated with this molecule, together with its poor ability to penetrate the intact corneal epithelium, also represents a major drawback to its clinical use. New effective and safe drug vehicles for ocular delivery of AmB are therefore urgently needed. Microemulsions (MEs) seem to be an interesting system, owing to their transparent appearance, thermodynamic stability and favorable viscosity. Knowledge of the process of formation of AmB-containing MEs, as well as a good understanding of the physical chemistry of such systems, would provide reliable information on the best conditions for the use of these systems as eye drops. The goal of this research was thus to make an approach to this subject by reviewing the main studies on the use of MEs as delivery systems for AmB in topical eye treatment.

Estudo de subemulsões e microemulsões contendo anfotericina B para administração oral

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Tratamento da pitiose em membros de equinos por meio de perfusão regional intravenosa com anfotericina B

Pós-graduação em Cirurgia Veterinária - FCAV

Avaliação clínico-laboratorial de cães naturalmente infectados por leishmaniose visceral, submetidos à terapia com anfotericina B

Pós-graduação em Medicina Veterinária - FMVZ

Complexos de inclusão de anfotericina B com derivados de ciclodextrinas e sua incorporação em microemulsões lipídicas biocompatíveis

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Microemulsões biocompatíveis de anfotericina B para administração oral: estudo estrutural, liberação in vitro e farmacocinética pré-clínica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeito da anfotericina B, extrato da casca de bartimão, ácido tânico purificado, DMSO e corticosteróide na tratamento da pitiose experimental em coelhos

Pós-graduação em Biologia Geral e Aplicada - IBB