A carregar...
Publicação
Profilaxia de leishmaniose visceral : a propósito de um caso clínico
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 784.91 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
A leishmaniose visceral é uma doença parasitária, com cerca de 400 000 novos casos por ano. Quando ocorre em doentes com VIH, devido à profunda imunossupressão, estes são mais propensos a recaídas. Assim, a profilaxia secundária é recomendada até à recuperação desta imunossupressão. Para ilustrar as dificuldades in vivo, é descrito um caso clínico de um doente co-infetado com VIH e LV e com IRC, que apesar da profilaxia secundária após tratamento da LV, apresenta duas recaídas. A primeira ocorreu passados 625 dias do primeiro tratamento, a tomar miltefosine (100mg/dia), e a segunda ocorreu passados 445 dias, a tomar AnfoBL (5mg/Kg de 4/4 semanas). A revisão da literatura existente sobre ensaios clínicos e casos esporádicos revelou onze estudos sobre profilaxia secundária em doentes com LV e VIH. Todos os estudos caraterizam-se pelo escasso número de doentes e sem significado estatístico. Miltefosine e pentamidina não apresentaram recaídas; e os antimoniais pentavalentes, AnfoBL e AnfoBCL apresentaram respetivamente: 18%; 20-40%; e 50% de recaídas. Existe a necessidade de estudos mais alargados para doentes co-infetados com VIH e LV. A IRC requer considerações especiais de ajuste de dose dos fármacos, especialmente quando acompanhada por hipoalbuminémia. Doentes com HCC requerem monitorização rigorosa por eventual hepatotoxicidade.
Visceral leishmaniasis is a parasitic disease with 400 000 new cases per year. When it develops in patients with HIV, due to profound immunosuppression, they are prone to relapse from VL subsequently. Therefore, secondary prophylaxis is recommended until the recovery of their profound immunosuppression is granted. To illustrate the in vivo difficulties, a real case is described of a patient suffering from HIV and VL along with CKD who, despite secondary prophylaxis after the first treatment of VL, had two relapses. The first happened 625 days after the first treatment and under miltefosine (100mg/day). The second relapse occurred after 445 days from the last relapse while he was receiving LAmphoB (5 mg/kg 4/4 weeks). The review of clinical trials and sporadic cases revealed eleven studies on secondary prophylaxis in patients with VL and HIV. All of them had a low number of subjects and were not statistically significant. Miltefosine and pentamidine showed no relapses; and antimony pentavalent, LAmphoB and AmphoBLC revealed: 18%; 20-40%; and 50% of relapses respectively. There is a need for more extensive studies on patients with HIV and VL. The renal failure requires special considerations for adjustments of medication doses especially when accompanied with hypoalbuminemia. Patients with CHC further require closer monitoring for eventual hepatotoxicity.
Visceral leishmaniasis is a parasitic disease with 400 000 new cases per year. When it develops in patients with HIV, due to profound immunosuppression, they are prone to relapse from VL subsequently. Therefore, secondary prophylaxis is recommended until the recovery of their profound immunosuppression is granted. To illustrate the in vivo difficulties, a real case is described of a patient suffering from HIV and VL along with CKD who, despite secondary prophylaxis after the first treatment of VL, had two relapses. The first happened 625 days after the first treatment and under miltefosine (100mg/day). The second relapse occurred after 445 days from the last relapse while he was receiving LAmphoB (5 mg/kg 4/4 weeks). The review of clinical trials and sporadic cases revealed eleven studies on secondary prophylaxis in patients with VL and HIV. All of them had a low number of subjects and were not statistically significant. Miltefosine and pentamidine showed no relapses; and antimony pentavalent, LAmphoB and AmphoBLC revealed: 18%; 20-40%; and 50% of relapses respectively. There is a need for more extensive studies on patients with HIV and VL. The renal failure requires special considerations for adjustments of medication doses especially when accompanied with hypoalbuminemia. Patients with CHC further require closer monitoring for eventual hepatotoxicity.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Leishmaniose visceral Profilaxia Doenças transmissíveis