Carta ao Editor. Revista da Sociedade Brasileira de Medicina Tropical 19:199-200, Jul-Set, 1986
TOPICAL PENTOSTAM IN AN ATTEMPT TO PRODUCE MORE RAPID HEALING
OF SKIN ULCERS DUE TO
LEISHMANIA BRAZILIENSIS BRAZILIENSIS
W e h a v e a lr ea d y d e s c r ib e d th e c o u r s e o f sk in u lcers d u e to th is parasite after intralesion al G lu ca n tim e1. B e c a u s e th er e a p p ea r ed to b e a slig h t r e s p o n s e o v e r 3 0 d a y s w e h a v e e x te n d e d o u r o b s e r v a tio n s t o th e u s e o f tw o to p ic a l p re p a ra tio n s o f P e n t o s ta m . T h e s e a re th e s o lu tio n o f P e n t o s ta m ( W e l lc o m e ) in o c u la te d in tr a le s io n a lly a n d P e n t o s ta m p o w d er m ix e d w ith A q u a p h o r in th e fo rm o f a c r e a m . O n c e a g a in w e h a v e c o m p a r e d th e r es u lt o f lo c a l tr ea tm e n t o f o n e u lc er w ith a n u n tre a te d le s io n in th e s a m e p a tien t w ith m u ltip le u lc e r s. O n e th ird o f o u r p a tie n t w ith in itia l cu ta n e o u s d is e a s e h a v e s u c h le s io n s in th e a rea w h e re w e w o rk 3. T h e m a x im u m ( R j ) a n d m in im u m ( R2) ra d iu s o f th e u lc e r w a s m e a s u r e d a n d th e a rea c a lc u la te d u s in g th e form u la : R i x R2 x T T .
T a b le 1 s h o w s th e re s u lts o f in tr a le s io n a l P e n to s ta m 3 0 0 m g S b v d a ily fo r 1 0 d a y s a t th e en d o f tr ea tm e n t in o n e p a tie n t a n d a fter 3 0 d a y s la ter in tw o o th e rs . In term s o f u lc e r s iz e n o b e n e fic ia i e ffe c t w a s a p p a r en t d u rin g th is tim e s p a n a lth o u g h u lc er s w ere o fte n th o u g h t to b e s h a llo w e r . U n lik e G lu c a n tim e P e n t o s ta m w a s n o t p a in fu l o n lo c a l in je ctio n .
P e n t o s ta m p o w d er ( 1 5 g ra m s ) w a s m ix e d w ith 2 0 m illilit re s o f w a te r a n d 15 g ra m s o f A q u a p h o r to fo rm a cre a m . T h is w a s a p p lie d in d o s e s o f 2 g ra m s ( 6 0 0 m g S b v) d a ily to th e su rfa c e o f th e u lc e r fo r 5 o r 1 0 d a y s . P u p o 6 rep o rted fa v o u ra b le re su lts u sin g a 1% tartar e m e tic c re a m a p p lie d d a ily a lth o u g h h e d id n o t g iv e d a ta .
T a b le 2 d e ta ils tre a tm e n t d u ra tio n a n d resu lts a fter v a ry in g p e rio d s o f o b s e r v a tio n s . O n c e a g a in n o b e n e fic ia i e ffe c t c o u ld b e d o c u m e n te d u s in g th e s iz e o f u lc er a t io n a s a m ea s u re m e n t a n d co m p a ris o n w ith a c o n tro l le s io n . T b re e o th e r p a tien ts (re su lts n o t p r e s e n te d ) w e r e tr ea ted w ith P e n to s ta m crea m for sin g le u lc er s w ith o u t v is ib le e ff e c t. O n e o f th es e p a tien ts d e v e lo p e d ery th em a a n d p a in o n th e s ix th d a y o f a p p lic a tio n w h ic h r e s o lv e d o n s to p p in g th e a p p lic a -tio n .
S in c e th e resu lts d o n o t s u g g e s t a n y p a tie n t b e n e fit w e h a v e s u s p e n d ed further in v es tig a tio n s . S c h m id t8 in 1 9 5 0 w a s a b le to re v ie w a n e x te n s iv e
T a b le 1
-Area in centimetres of treated and control lesions before and after local treatment with Pentostam.
Patient
code
LTCP
Measurements of ulcer in centimetres
Duration of
observation
in days
Age/Sex
Control
Lesions
Intralesional
Pentostam
Before
After
Before
After
3 4 5 1 4 / F 1.3 2 .8 1 .6 6 .1 3 0
3 3 9 1 6 /M 1 .2 1 .4 3.1 7 .0 3 0
3 6 0 3 2 / F 1.6 2 .0 1 .4 2 .1 1 0
T a b le 2 - R e s u lt s o f a p p lic a tio n s o f P e n t o s ta m cr ea m o v e r v a ry in g tim e p e rio d s
Measurement of ulcer in centimetres
No. of days
No. of days
assessed after
Control
Lesions
Treated
Lesions
Patient code
of treatment
treatment
Before
After
Before
After
7 6 0 5 1 3 .1 3 .1 1 2 .6 1.1
7 6 9 5 1 2 .0 2 .0 2 .9 2 .9
7 6 9 5 15 2 .0 2 .0 2 .9 2 .9
8 2 6 5 1 1 1 .8 1 1 .8 0 .8 0 .8
8 2 6 5 15 1 1 .8 1 1 .8 0 .8 0 .7
3 6 0 1 0 1 1 .6 2 .0 0 .8 0 .3
3 4 5 1 0 2 0 1 .3 2 .8 1 .3 0 .5
3 3 9 1 0 2 0 1 .2 1 .9 0 .8 1 .2
R e ce b id o para p u b lic a çã o em 1 2 / 1 / 1 9 8 6 .
Carta ao Editor. Revista da Sociedade Brasileira de Medicina Tropical 19:199-200, Jul-Set, 19861
litera tu re o n lo c a l in je ctio n th era p y w ith s o lu s tib o s a n . S o la n o
et al
9 h a v e r e c e n tly rep o rted fa v o u r a b le o n th e ef fe ct o f in tr a le s io n a l G lu c a n t im e . A sh o r t o b s e r v a tío n p e rio à o n ly w a s p o s s ib le in o u r p a tie n ts w ithLeish-mania braziliensis braziliensis
(L b b ) b e c a u s e th e y req uire s y s t e m ic p e n ta v a le n t a n tim o n ia l th er a p y . T h e fa v o u ra b le r esu lts o f p r e v io u s w o rk ers m ig h t b e s im p ly d u e to s p o n ta n e o u s h e a lin g w h ic h w e k n o w to o c c u r e v e n w ith L b b 4 . T h e b e s t w o rk a v a ila b le o n th is m eth o d is in a n im a l m o d e ls , t h a t o f R i c h e n s 7 . C o m p a r -in g th e e ff e c ts o f s u b c u ta n e o u s a n d -in tr a le s io n a l ro u tes o f P e n t o s t a m o nLeishmania major
in fe c tio n s i n B a lb C m ic e h e s h o w e d n o b e n e fit fro m in tr a le s io n a l a p p lic a tio n e v e n u s in g v e r y h ig h d o s e s ( 4 0 0 m g S b v per K g .). A l s o th e in d iv id u a l r e s p o n s e w a s le s s p r ed icta b le w h en lo c a l tre a tm e n t w a s u s ed .T h er e is a ra tio n a l fo r try in g lo c a l p e n ta v a le n t a n tim o n y th era p y s in c e th e a m o u n t o f d ru g fro m a s y s t e m ic d o s e co n c en tr a t ed in th e s ite o f a sk in le s io n m a y b e v er y lo w 5. T h er e is s o m e u n p u b lis h ed ev id e n c e th a t P e n t o s ta m cre a m m a y h a v e e f f e c t a p p lie d to
Leishmania braziliensis panamensis
le s io n s inMystromys albicaudatus.
( M c G r e e v y P .B .: p e rs o n a l co m m u n ic a tio n ). O th er w o rk ers in aLeishmania
tropica
m o u s e m o d el d id n o t th in k to p ic a l a n tim o n y th era p y s h o w e d e ffe c t2. F u rth er o b s e r v a tio n s are in d ica te d to cla rify t h e s e c o n flic tin g res u lts .R E F E R E N C E S
1. A ristim u n o B arrios L , C o st a J M L , N e tt o E M , V e x e n a t C O R , C u b a C C , M a rsd en P D . In tra lesio na l gluca ntim e in
Leishmania braziliensis braziliensis
in fectio n s. T r a n sa ctio n s o f the R o y a l S o c ie ty o f T ro p ica l M ed ic in e and H y g ie n e , in p ress.2 . E l-o n J , J a co b s G P , W itz tu m E , G r een b la tt C L . D e v e lo p m e n t o f to p ica l trea tm en t for cu ta n eo u s leish m a n ia sis ca u se d b y
Leishmania major
in e x p erim enta l a n im ais. A n tim ic ro b ia l A g e n ts and C h em o th era p y 26: 7 4 5 - 7 5 1 , 1 9 8 4 .3. L la n o s -C u e n ta s E A , M a rsd en P D , L a g o E L , B arreto A C , C u b a C u b a C , J o h n so n W D . H u m a n m u c o c u ta n e o u s leis h m a n ia sis in T rês B ra ço s, B a h ia -Brazil. A n area o f
Leishmania braziliensis braziliensis
transm ission. II. C u tan eous d isea se. P resentation and evolution. R ev ista d a S o cied a d e B rasileira d e M e d icin a T ropical 17: 1 6 9 -1 7 7 , 1 9 8 4 .4 . M a rsd en P D , T a b d a M S , B arreto A C , C u b a C C . Spon ta neou s healing o f
Leishmania braziliensis
braziliensis
skin ulcers. T ransaction s o f the R o y al S o ciety o f T ropical M ed icin e and H yg ien e 7 8 : 5 6 1 -5 6 2 , 1 9 8 4 .5. M arsden P D . P entava lent antim onials: o ld drugs for n ew d isea ses. R evista d a S o cied a d e Brasileira de M ed icin a T ropical 18: 1 8 7 -1 9 8 , 1 9 8 5 .
6 . P up o J A . L eishm an iose tegum entar. E pidem iologia, profilaxia e tratam ento d a leishm an io se. A m erican a S cie n cia M e d ic a 4: 3 8 7 - 4 0 9 , 1 9 2 6 .
7. R ich en s J A . T h e effects o f sodium stibogluconate o n
Leishmania major
infections in B a lb C m ice: subcutaneous and intralesional routes o f administra-tion com pared. M im eographed d o cu m en t L ondon 3 4 pp., 1 9 8 3 .8. S ch m idt H . A n a dv an ce in the therapeutics o f pentavalent antimony: solustibo sa n (sodium antim ony g lu co n a te). T h e Jou rn al o f T ro p ica l M ed icin e 53: 9 5 -1 0 2 , -1 9 5 0 .
9 . S o la n o A E , H id a lg o H H , Z eled o n R A . T rata m ien to intra lesio n a l e x ito s o d e la leish m a n ia s is por
Leish
mania braziliensis panamensis
co n g lu ca n tim e. M ed icin a C u tis I L A 12: 1 9 -2 4 . 1 9 8 4 .J .M .L C o sta , L. A ristim u n o Barrios, E .M . N e tto e P .D . M arsden N ú c le o de M edicin a T ropical e N u triçã o da U n iversid ad e de Brasília.
