de Oliveira Duque Maria Cristina, Quintão Silva José Jayme, Soares Priscilla Andrade Oliveira, Magalhães Rodrigo Sousa, Horta Adriene Paiva Araújo, Paes Lucia Regina Brahim, Rosandiski Lyra Marcelo, Pimentel Maria Inês Fernandes, de Fátima Antonio Liliane, de Camargo Ferreira E Vasconcellos Érica, Saheki Maurício Naoto, de Almeida Marzochi Mauro Celio, Valete-Rosalino Cláudia Maria, de Oliveira Schubach Armando
Secretaria Municipal de Saúde, Timóteo, Minas Gerais, Brazil; Programa de Pós-Graduação Stricto Sensu em Pesquisa Clínica, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Secretaria Municipal de Saúde, Timóteo, Minas Gerais, Brazil.
Acta Trop. 2019 May;193:176-182. doi: 10.1016/j.actatropica.2019.03.007. Epub 2019 Mar 6.
Cutaneous leishmaniasis (CL) is not a life-threatening condition. However, its treatment can cause serious adverse effects and may sometimes lead to death. Recently, safer local treatments have been included among therapies acceptable to New World CL cases, but the use of intralesional meglumine antimoniate (IL-MA) is recommended to be performed in reference centers, for patients with single cutaneous lesions <3 cm in diameter at any location except the head and periarticular regions; the volume of injected MA should not exceed 5 mL. In this study we compared two groups of patients with CL treated with MA in a primary health care unit in Brazil. Patients were treated with systemic MA (n = 76) or IL-MA (n = 30). In the IL-MA group, 93% of patients had one or more of the following lesion characteristics: two or more lesions, lesions >3 cm in diameter, lesions located in the head or in periarticular regions, or had been administered IL-MA volumes >5 mL. Patients responded well (68.4% and 66.7% for the MA and IL-MA groups, respectively). When a second cycle of treatment was necessary, the responses were 72.4% and 90%, respectively. There were no significant differences between groups. In the IL-MA group, 43% had mild to moderate adverse effects, without needing treatment discontinuation. Results suggest that the treatment of CL lesions with IL-MA is simple, efficient, and safe.
皮肤利什曼病（CL）并非危及生命的疾病。然而，其治疗可能会引起严重的不良反应，有时甚至可能导致死亡。最近，更安全的局部治疗方法已被纳入新大陆CL病例可接受的治疗方案中，但推荐在参考中心对除头部和关节周围区域外任何部位直径<3 cm的单发皮肤病变患者使用病灶内葡甲胺锑酸盐（IL-MA）进行治疗；注射的MA体积不应超过5 mL。在本研究中，我们比较了巴西一家初级卫生保健机构中两组接受MA治疗的CL患者。患者分别接受全身MA治疗（n = 76）或IL-MA治疗（n = 30）。在IL-MA组中，93%的患者具有以下一种或多种病变特征：两个或更多病变、直径>3 cm的病变、位于头部或关节周围区域的病变，或接受的IL-MA体积>5 mL。患者反应良好（MA组和IL-MA组分别为68.4%和66.7%）。当需要进行第二个疗程的治疗时，反应率分别为72.4%和90%。两组之间无显著差异。在IL-MA组中，43%的患者有轻度至中度不良反应，但无需停止治疗。结果表明，用IL-MA治疗CL病变简单、有效且安全。
