Eficácia do sulfato de aminosidine na leishmaniose visceral grave, resistente ao tratamento com antimonial pentavalente

Abstract

Descreve-se um caso de calazar grave resistente a dez cursos de antimonial petitavalente (glucantime) à base de 20mg de Sb5/kg/dia, que respondeu favoravelmente ao sulfato de aminosidine intramuscular na dose de 20mg/kg/dia por 20 dias, repetido após 20 dias. O parasitismo esplénico passou de 50 parasitos por campo a 3 parasitos em 10 campos logo após a primeira série de sulfato de aminosidine, tornando-se negativo depois de sete meses. A melhora clínica foi imediata, com redução gradual da hepatoesplenomegalia, e desaparecimento 26 meses após. Neste período aumentou 13 kg. Após o uso de aminosidine a reação de Monténégro tornou-se positiva e as células mononucleares responderam quando estimuladas com antígenos de leishmânia.A grave kala-azar infection in a 14 years old boy is described. The leishmanial infection failed to respond to ten interrupted courses of glucantime of variable duration (14-56 days) at a dose of 20mg Sb5/kg/day. However a favorable response ocurred to intramuscular aminosidine sulphate (20mg/kg/day) for 20 days. This same regimen was repeated 20 days later. After the first treatment splenic puncture parasite density fell from 50 amastigotes per oil immersion field to 3 amastigotes in 10 fields. A further splenic puncture 7 months after treatment was negative. The marked hepatoesplenomegaly gradually resolved over 26 months follow up and he gained 13 kilogramas in weight. After aminosidine sulphate therapy his Montenegro reaction become positive and his lymphocytes responded to leishmania antigens.

Keywords

• Aminosidine no calazar
• Calazar resistente ao glucantime
• Calazar grave
• Aminosidine in kala-azar therapy
• Kala-azar unresponsive to glucantime
• Severe kala-azar