RESUMO
Pentavalent antimony (Sbv), formulated as sodium stibogluconate or meglumine antimoniate, is the standard treatment for the leishmaniases. In 16 of 17 consecutive, prospectively observed patients in Washington D.C., serum levels of amylase and lipase rose to abnormal values after therapy with sodium stibogluconate was started; 12 of 17 had symptoms of pancreatitis. Sbv therapy was continued to completion in 7 of 17 patients and interrupted in 10 of 17. Pancreatitis improved in every patient after Sbv therapy was stopped. Sbv treatment was resumed after brief interruptions in 6 of 10 patients. All six of these patients had flares of pancreatitis, but each completed therapy. Subsequently, we measured amylase and lipase levels in stored sera from 32 patients treated in Peru with either sodium stibogluconate or meglumine antimoniate for mucosal leishmaniasis. In all 32 Peruvian patients, serum amylase and lipase rose to abnormal levels during Sbv therapy; 11 of 32 had symptoms of pancreatitis. Standard Sbv regimens induce pancreatitis in almost all patients, but continued therapy is often tolerated; pancreatitis subsides when therapy is stopped, and rechallenge may be tolerated after a brief halt in treatment.
Assuntos
Gluconato de Antimônio e Sódio/efeitos adversos , Pancreatite/induzido quimicamente , Adulto , Amilases/sangue , Gluconato de Antimônio e Sódio/administração & dosagem , Antiprotozoários/administração & dosagem , Antiprotozoários/efeitos adversos , District of Columbia , Humanos , Leishmaniose Mucocutânea/tratamento farmacológico , Leishmaniose Visceral/tratamento farmacológico , Lipase/sangue , Masculino , Meglumina/administração & dosagem , Meglumina/efeitos adversos , Antimoniato de Meglumina , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Compostos Organometálicos/efeitos adversos , Pancreatite/enzimologia , Peru , Estudos ProspectivosRESUMO
Two U.S. Army soldiers acquired skin lesions of cutaneous leishmaniasis and enlarged lymph nodes while stationed in Panama. In the first case, parasites were histologically identified and cultured from the skin lesion and a contralateral lymph node. In the second case, parasites were cultured from an enlarged lymph node in a nodal group draining the lesion. These findings suggest that metastasis of cutaneous leishmanial infection may be more common than is generally appreciated.
Assuntos
Leishmaniose/patologia , Linfonodos/patologia , Adulto , Humanos , Masculino , Medicina Militar , Panamá , Estados Unidos/etnologiaRESUMO
A new, formalin-inactivated vaccine for Venezuelan equine encephalitis (VEE) virus (C-84), prepared from an attenuated vaccine strain of virus (TC-83), was tested in humans. Only occasional, mild, local and systemic reactions were noted in 28 volunteers; no meaningful changes in clinical laboratory values occurred. The vaccine augmented preexisting titers of serum neutralizing antibody to VEE virus in seropositive recipients of TC-83 vaccine, and it induced high titers of neutralizing antibody in nonimmune subjects after one primary and two booster vaccinations. Circulating antibody persisted for at least 14 months in these persons. The neutralizing antibody produced after one dose of C-84 vaccine in immune subjects and after booster doses in nonimmune subjects had broad cross-reactivity within the VEE virus complex. The C-84 vaccine induced a VEE virus-specific lymphocyte transformation response. The vaccine was safe, and immunologic results showed it to be highly antigenic in healthy immune and nomimmune adults.