Avaliacao da toxicidade da n-metilglucamina no tratamento da leishmaniose tegumentar americana em servico publico de referencia de Minas Gerais

Abstract

A cross-sectional study was conducted based on a retrospective analysis of 78 patients with mucocutaneous leishmaniasis (CL) treated between January 1995 and December 2005 in a Minas Gerais State public referral hospital for infectious diseases in order to evaluate N-methylglucamine toxicity. Diagnosis criteria for CL were based onepidemiology and clinical findings associated with one or more of the following: a positive Montenegro reaction; a positive serology for Leishmania; a positive direct examination for Leishmania, compatible biopsy, positive polymerase chain reaction (PCR) for Leishmania,positive inoculation of guinea pig with Leishmania. We described the location and characteristics of lesions and the presence of comorbidities. Besides registering any clinical adverse reactions, we analyzed results of tests done before and after antimonyal administration. We compared appearance of adverse reactions during treatment with other morbid conditions that could predispose to these effects. Among analyzed patients, 64(82,1%) were male, 48(61,5%) non-white and mean age was 49,9 years. During the study period, and during therapy with antimonyal, three (3,8%) patients died, three (3,9%) showed upper airways obstruction, one (1,3%) developed pancreatitis and four (5,3%)symptomatic hypotension. Fifteen (20%) patients showed asthenia, nine (11,8%) myalgia; forteen (18,4%) arthritis or arthralgia; forteen (18,4%) nausea or vomiting. Adverse clinical events were reported by forty (51,3%) patients and all had one ore more abnormalities on the tests performed: 52 (78,5%) patients showed EKG changes; 35 (44,9%) AST elevation; twenty (25,6%) ALT elevation; sixteen (72,7%) change of amylase values; 24 (82,8%) of lipase values; forteen (20,3%) of creatinine levels; 24(35,3%) of urea levels; 21 (34,4%) had anemia; and eight (13,1%) leucopenia. We conclude that despite the potential toxicity of N-methylglucamine most side effects were mild and most patients completed treatment. The death of one case seemed to be related tothe medication.