Treatment of Viscelar Leishmaniasis the Use of allopurinol and ketoconazole

Abstract

Aim: Leishmania is traditionally treated with pentavalent antimony compounds (Stibogluconate sodium = pentostam, methylglucamine antimonate = Glucanim). Drugs such as pentamidine (Lomidine), liposomal amphotericin B, interferon-γ, granulocyte-macrophage colony-stimulating factor, aminosidine, miltefosine are known to be successful in treatment with or without other drugs in resistant cases to pentavalent antimony compounds. 

An alternative treatment regimen is the use of drugs such as allopurinol and ketoconazole, which are less toxic. In this study, the efficacy of allopurinol and ketaconazole in combination therapy was investigated. Method: Oral ketoconazole and allopurinol treatment was evaluated in 6 children with visceral leishmania in Mersin University Faculty of Medicine. All the cases were given Allopurinol (20mg / kg / day / 2 doses) and ketoconazole (5mg / kg / day / 2 doses) for 1 month. Result: After one month of treatment, complete remission was observed in four cases, but no remission was achieved in two cases. One of the cases that could not be remitted was diagnosed in another center and was given Glucantim treatment. When fever, fatigue and pallor complained to us, it was evaluated as a relapse on the appearance of leishmania amostigotes in bone marrow. Allopurinol and ketoconazole therapy started. The patient was admitted to treatment with remission and applied to us with the same findings again forty-five days after the end of the treatment. Amphotericin B (3 mg / kg / day) was given as the second relapse. In the other case reactivation occurred in thirty-sixth day after initiation of treatment. Conclusion: Five valuable antimony compounds and Amphotericin B can be used in the treatment of leishmenia. Nevertheless, allopurinol and ketoconazole, which are used orally, are safe and inexpensive treatment methods and we think that it may be another treatment option in our country.

Keywords

• Leishmania treatment,alloprurinol,ketakonasol

Visseral Leishmaniasis (Kala Azar) tedavisinde allopurinol ve ketakonazol kullanımı

Abstract

Amaç: Kala-azar klasik olarak beş değerlikli antimon bileşikleri (Stibogluconate sodyum = pentostam, methylglucamine antimoniate = Glucantim) ile tedavi edilir. Beş değerlikli antimon bileşiklerine dirençli vakalarda pentamidine (Lomidine), lipozomal amfoterisin B, interferon-γ, granülosit-makrofaj koloni stimule edici faktör, aminosidin, miltefosine gibi ilaçların diğer ilaçlarla birlikte veya tek başlarına tedavide başarılı olduğu bildirilmektedir. Alternatif bir tedavi rejimi de daha az toksik olan allopurinol ve ketakonazol gibi ilaçların kullanımıdır. Bu çalışmada allopurinol ve ketakonazolün birlikte kullanımı ile tedavi etkinliği araştırılmıştır. Yöntem: Mersin Üniversitesi Tıp Fakültesinde viseral leishmania tanısı ile izlenen 6 çocuk hastada bir yıl içinde oral ketakonazol ve allopürinol tedavisi değerlendirildi. Vakaların tamamına 1 ay süreyle Allopürinol (20mg/kg/gün/2 dozda) ve ketakonazol (5mg/kg/gün/2 dozda) verildi. Bulgular: Bir aylık tedavi sonrasında dört vakada tam remisyon görülürken iki vakada remisyon sağlanamadı. Remisyon sağlanamayan vakaların biri başka bir merkezde tanı almış olup Glucantim tedavisi verilmişti. Ateş, halsizlik ve solukluk yakınması ile bize başvurduğunda kemik iliğinde leishmania amostigotlarının görülmesi üzerine relaps olarak değerlendirildi. Allopurinol ve ketakonazol tedavisi başlandı. Tedavi ile remisyonda kabul edilen hasta tedavi bitiminden kırkbeş gün sonra tekrar aynı bulgularla bize başvurdu. İkinci relaps olarak değerlendirilerek Amfoterisin B (3mg/kg/gün) tedavisi verildi. Remisyon sağlanamayan diğer vakada tedavi başlangıcından sonraki otuzaltıncı günde reaktivasyon gelişti. Amfoterisin tedavisi verilerek remisyon sağlandı. Sonuç: Kala-azar tedavisinde beş değerli antimon bileşikleri ve Amfoterisin B kullanılabilir. Bununla birlikte oral olarak kullanılan allopürinol ve ketakonazol güvenli ve ucuz bir tedavi yöntemi olarak ülkemizde diğer bir tedavi seçeneği olabileceği kanısındayız.

Keywords

• Leishmania tedavisi,allopürinol,ketakonasol

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