Νεότερα δεδομένα πάνω στη θεραπεία της λεϊσμανίωσης του σκύλου


Δημοσιευμένα: Ιαν 31, 2018
Λέξεις-κλειδιά:
λεϊσμανίωση σκύλος θεραπεία.
M. N. SARIDOMICHELAKIS (Μ. Ν. ΣΑΡΙΔΟΜΙΧΕΛΑΚΗΣ)
A. F. KOUTINAS (Α.Φ. ΚΟΥΤΙΝΑΣ)
M. E. MYLONAKIS (Μ.Ε. ΜΥΛΩΝΑΚΗΣ)
Περίληψη

Για τη θεραπευτική αντιμετώπιση της λεϊσμανίωσης του σκύλου χρησιμοποιούνται η αντιμονιοΰχος μεγλουμίνη, η αλλοπουρινολη, η παρομομυκίνη (αμινοσιδίνη) και η αμφοτερικίνη Β. Με μόνη εξαίρεση την αντιμονιοΰχο μεγλουμίνη όπου έγιναν φαρμακοκινητικές μελέτες(75 mg/Kg ΣΒ κάθε 12 ώρες, υποδόρια), τα δοσολογικά σχήματαγια την αλλοπουρινολη (10-20 mg/Kg ΣΒ κάθε 12 ώρες,από το στόμα), την παρομομυκίνη (5-10 mg/Kg ΣΒ κάθε12 ώρες, ενδομυϊκά ή υποδόρια) και την αμφοτερικίνη Β(0,5-0,8 mg/Kg ΣΒ, 2-3 φορές την εβδομάδα, μέχρι την ολικήδόση των 8-15 mg/Kg ΣΒ, ενδοφλέβια) βασίζονται στηνκλινική εμπειρία. Οι παρενέργειες από τη χορήγηση των δυο πρώτων φαρμάκων είναι σχετικά σπάνιες και ήπιες. Αντίθετα, η θεραπεία με παρομομυκίνη (ωτοτοξική, νεφροτοξική) και με αμφοτερικίνη Β (νεφροτοξική) μπορεί να συνοδεύεται από βαριές και επικίνδυνες για τη ζωή του ζώου παρενέργειες. Αν και με τα παραπάνω φάρμακα επιτυγχάνεται η κλινική ίαση στα περισσότερα ζώα και μειώνεται,χωρίς όμως να εξαφανίζεται, ο κίνδυνος μετάδοσης της Leishmania spp. στους φλεβοτόμους, η εξουδετέρωση του παρασίτου τις περισσότερες φορές δεν επιτυγχάνεται. Η μακροχρόνια θεραπεία με αλλοπουρινολη σε συνδυασμό με αντιμονιοΰχο μεγλουμίνη, σε κύκλους των 20-30 ημερών, θεωρείται το αποτελεσματικότερο και το λιγότερο τοξικό θεραπευτικό σχήμα. Η επανειλημμένη χρησιμοποίηση της αντιμονιοΰχου μεγλουμίνης συντελεί στην ανάπτυξη ανθεκτικών στελεχών του παρασίτου απέναντι στο φάρμακο αυτό. Η θεραπεία θεωρείται οριστική μόνο όταν το αποτέλεσμα της δοκιμής PCR στο μυελό των οστών είναι αρνητικόσε δυο διαδοχικές εξετάσεις, σε διάστημα 6 μηνών η μία από την άλλη. Η χρησιμοποίηση των κυτταροκινών INF-γ, IL-2,IL-12, που απελευθερώνονται από τα ενεργοποιημένα Th-1 λεμφοκύτταρα, ενδέχεται στο μέλλον να αυξήσει τις πιθανότητες για οριστική ίαση.

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Αναφορές
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