Meglumina en series terapéuticas de 10 días en niños con leishmaniosis tegumentaria americana

La catedra de Medicina Tropical de la Universidad Central de Venezuela viene empleando el antimoniato de meglumina en series terapeuticas de 10 dias en el tratamiento de leishmaniosis tegumentaria americana, la cual continua como problema de salud del medio rural venezolano. Se evalua una experiencia con una dosis de 70 mg/kg/dia de meglumina en ninos con la enfermendad. A los pacientes con presuncion diagnostica de leishmaniosis tegumentaria americana (clinica y antecedentes epidemiologicos) se les efectuo la prueba de leishmania, la demostracion de anticuerpos flurescentes antileishmania y la visualizacion de amastigotes en frotis tenidos con Giemsa. Los casos identificados ingresaron al Hospital Universitario (Pediatria medica infecciosa), recibieron 70 mg/kg/dia de antimoniato de meglumina en series terapeuticas de 10 dias con reposo intercalados por el mismo numero de dias. Se incluyeron 33 ninos con la enfermedad, 21 de genero femenino (64%) con promedio de edad 7,12 anos y predominio de escolar (70%). Del Estado Miranda procedia el 85%, una sola ulcera la tenia el 88%, localizada en miembros inferiores (49%). La Leishmanina y los anticuerpos fluorescentes antileishmania fueron positivos en todos los pacientes y el frotis para amastigotes en 45%. Dos series de antimoniato de meglumina las recibio 91% de los pacientes; una de 10 dias 6%. Egresaron con cicatrizaciones de sus procesos ulcerosos y fueron evaluados durante seis meses en la consulta de endemias rurales y no se evidenciaron recaidas. La variedad cutanea localizada de la enfermedad fue la unica identificada, el Estado Miranda continua aportando la mayoria de los pacientes atendidos en medicina tropical. El antimoniato de meglumina en leishmaniosis tegumentaria americana a la dosis de 70 mg/kg/dia en series terapeuticas fue tan eficaz como la anterior de 100 mg/kg/dia que dejo de administrarse hace ocho anos.(AU) The Tropical Medicine Department of the Universidad Central de Venezuela employs the meglumine pentavalent antimonial in series of 10 days of treatment for American Tegumentary Leishmaniosis, which continues being a health problem in the Venezuelan rural areas. We are reporting a clinical experience of treatment in children at a dose of 70 mg/kg/day. Patients with diagnostic suspicion of American Tegumentary Leishmaniosis (clinical and epidemiologic antecedents) who attended the Rural Endemics Clinic at the Instituto de Medicina Tropical of the Universidad Central de Venezuela and to the Medical Infectious Pediatrics Service at the Hospital Universitario de Caracas (HUC), were tested for leishmanine, fluorescent antileishmania antibodies and for the presence of amastigotes of the parasite in smear for apposition from the ulcer that were treated by the Giemsa method. Patients hospitalized at the Medical Infectious Pediatric Service (Hospital Universitario de Caracas) received 70 mg/kg/day of meglumine pentavalent antimonial during 10 days, a rest period of 10 days without treatment and, if 20 days after ulcers were unhealed, was administred a new 10 days meglumine pentavalent antimonial series. We included 33 children with the disease with a mean age of 7,12 years, 70% in school age and 30% preschool children, and 21 (64%) were girls. The 85% of patients came from Miranda`s state, 88% had only ulcer and in 49% of them the lesions where localized in the legs. The apposition smear showed Leishmania amastigotes in 45% od cases. One series of treatment was given to 91% of cases, two children received two series and one three. At discharge from the hospital all ulcers were healed and follow-up control for a 6 months period showed no relapses. The cutaneous localized from was the clinical form of presentation in the children studied. The great majority of patients that assits to the Tropical Medicine Institute come from the Miranda`s state area...(AU)