Treatment of Viscelar Leishmaniasis the Use of allopurinol and ketoconazole

Year 2019, Volume: 12 Issue: 1, 107 - 112, 28.04.2019

Asuman Akar , Necdet Kuyucu

https://doi.org/10.26559/mersinsbd.458041

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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