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Ensaios terapêuticos com o TWSb (Dimercaptossuccinato de Antimónio) na bilharzíase vesical: I- resultados obtidos na enfermaria escolar (Hospital do Ultramar) em Lisboa: II- resultados obtidos no Hospital de S. Paulo de Luanda: III- resultados obtidos na Guiné na enfermaria da missão de endemias
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1- Três lotes de doentes (67) com bilharzíase vesical foram tratados com TWSb (dimercaptossuccinato de antimónio e sódio) em soluto a 10% em água destilada ou soro fisiológico:
a) o período de tratamento foi de 5 dias em 21 doentes, de 4 em 8 casos e de 3 dias em 38;
b) a via de administração usada foi a intravenosa em 7 doentes, a intramuscular em 57 e ambas em 3 casos;
c) a dose médica total foi de 0,050g por quilo de peso do doente, utilizando-se, respectivamente, como doses mínimas e máximas, no 1º grupo entre 1,25 e 2,1g, no 2º grupo 0,80 e 1,3g e no 3º uma dose padrão de 1,2g em 38 doentes, independentemente do seu peso, e 1,6g nos restantes 5;
2- A maioria tinha outras parasitoses comuns dos trópicos e quase todos tinham ancilostomíase. Foram hospitalizados para ficar ao abrigo de reinfestações e no último grupo de 38 doentes, tratados nas condições em que habitualmente se encontram nas zonas rurais endémicas dos trópicos, sem qualquer medicação adjuvante antes do tratamento específico;
3- Os doentes foram reexaminados com regularidade, fazendo-se pesquisa de ovos viáveis de S. haematobium no sedimento urinário logo depois do fim de tratamento e, ulteriormente, com exames semanais, quinzenais ou mensais.
Os períodos de controle foram para o 1º grupo de doentes entre 68 e 132 dias para o 2º de 118 e para o 3º de 62 dias;
4- Num total de 67 doentes, após um período de observação entre 62 e 132 dias depois de início de tratamento, verificou-se uma percentagem de curas de 97%.
5- Em dois doentes do 1º grupo registaram-se recidivas, definidas pelo reaparecimento de ovos viáveis no sedimento urinário, respectivamente ao 40º dia depois de início do tratamento, com uma posologia total de 1,25 e ao 61º dia após uma dose total de 1,6g.
Em três doentes do 2º grupo, os que receberam doses totais mais baixas (respectivamente 0,8, 0,9 e 1,1g) encontraram-se ao 68º dia ovos no sedimento urinário, que em contacto com água libertaram miracídios. Porém, em novos controles, ao 118º dia a pesquisa de ovos foi negativa;
6- Entretanto em consideração com todos os efeitos secundários atribuíveis ao medicamento, estes manisfestaram-se em elevada percentagem de doentes (75%).
Foram predominantes as perturbações gastrintestinais, traduzidas principalmente por vómitos, isoladamente ou acompanhados de náuseas ou dores abdominais. Em grande maioria dos doentes tais acidentes consistiram apenas em vómitos depois duma injecção, que podiam ou não repetir-se nas seguintes.
Foram passageiros, não afectaram seriamente os doentes não obrigaram à interrupção terapêutica e não deixaram sequelas permanentes. Foi aparente que a via intravenosa e as doses mais elevadas desencadeiam mais acidentes que a intramuscular.
Somente em 4 doentes (6% da totalidade) as manifestações secundárias, particularmente os vómitos, constituíram perturbações sérias, num dos doentes levando a uma situação grave (estado sincopal e desidratação, requerendo terapêutica de urgência);
7- Admite-se que o manifestação de efeitos secundários possa ser devida à concomitância de outras parasitoses, particularmente a ancilostomíase, e desnutrição, ocorrências que são habituais entre as populações rurais dos trópicos. E, efectivamente, a toxidade do medicamento pareceu aumentada no último lote de doentes em que utilizou a dose-padrão de 1,2g, sem calcular a dose individual por quilo de peso, administrada em três dias sucessivos;
8- Outras determinações laboratoriais feitas em alguns doentes, incluindo quadro hemático, proteinemia, reacções de Hanger etimol, medições de tensão arterial e electrocardiogramas, não mostraram quaisquer perturbações dignas de nota;
9- Comparativamente à conhecida eficácia e toxicidade dos antimoniais usados até à data no tratamento da bilharzíase, o TWSb, conservando uma toxicidade apreciável, mas passageira e pouco grave mostra manifesta vantagem, sobretudo pela comprovada eficácia num período de tratamento muito mais curto (3-5 dias). A ocorrência de efeitos secundários, a nosso ver, requer ainda cuidadosa investigação no sentido de procurar eliminá-los. A sua redução substancial alargará a utilidade terapêutica do medicamento.
1-Trois groupes de malades de bilharziose vésicale ont été seumis à un traitement au TWSb (dimercaptosuccinate d’antimoine) sous forme de solution à 10% dans l’eau ou sérum phisiologique: a)La durée du traitement aété de cinq jour en 21 malades, de quatre jour en 8 cas et de trois en 38; b)La void’administration esée a été intaveineuse en 7 malades intramusculaire en 57 et tous les deux en 3; c)Le dosage moyen total a été de 0,050g/Kg en utilisant comme doses minimum et maximum respectivement: dans le 1er. Groupe 1,25 et 2,1g; dans le 2ème. 0,80 et 1,3g; et dans 3 ème., on a utilize un dosage standard de 1,2g en 38 malades, sans calculer le poids des maladies, et 1,6g en 5; 2- La majorité des maladies étaient porteurs d’autres parasitoses communes des tropiques et avaient ancylostomiase. Ils ont été hospitalisés pour éviter des réinfections et, dans l dernier groupe de 38 malades, on a fait le traitement dans les conditions qui nousavons trové les malades dans les zones rurales; 3- Des controles reguliers, examinant des oeufs viables de S. haematobium dans lúrine, ont été fait, après la fin du traitement et avec des examens hebdomadaires, tous les quinze jours et mensuels. Les periodes de controles furent par chacun des groupes 68 et 132, 118 et 62 jours; 4- Dans un total de 67 malades, après une période d’observation 62 et 132 jours après le début du traitement, on a vérifié un pourcentage de guérisons immédiates de 97 %.; 5- En 2 malades du 1er. Groupe on a enregistré deux rechutes (réaparition des oeufs viables dans l’urine) respectivement au 40 ème. et 61 éme. jours apr´`es le début du traitement, avec des doses totales de 1,25g et 1,6g. En 3 malades du 2ème. groupe, ceux qui ont reçu les doses les plus faibles (0,8, 0,9 et 1,1g) on trouvé au 68 éme. jour des oeufs dans l’urine qui, en contact avec l’eau, ont liberté des miracides. Mais un nouveau examen au 118 ème. jour a été négatif; 6- Dans l’ensemble, les effects sécondoires du TWSb ont été observes dans un grand pourcentage de maladies (75%), mais ils se bornèrent à des vomissements accompagnés de nausées ou douleurs abdominales dans la grande majorité des malades, seulement des vomissements aprés une injection, qui pourraient se r´péter dans les suivantes. Ils ont été bénins et passagers, sans affecter sérieusement les maladies, n’obligèrent pas l’interruption du traitement et ne laissèrent des sequelles. La voie intraveineuse et les dosages plus élevés ont été plus toxiques. Il est à remarquer que seulement en 4 malades (6% de l’ensemble) on a observe des effects sécondaires peu sérieux, particulièrement des vomissements; un malade a eu un état syncopal; 7- Bien qu’il soit dificille de se prononcer, peut être que les effects secondaires soient dus à la présence d’autres parasitoses, particulièrement l’ancylostomiase ou malnutrition, conditions qui sont habituelles parmi les populations des tropiques. En effect, les vomissements ont été becaucoup plus remarques dans le dernier groupe de maladies, dans lesquels une dose standard de 1,2g a été administrée en trois jours; 8- D’autres determinations ont été faites en quelques maladies: quadre hématologique, proteinémie, preuves du timol et Hanger, tension artériel et E. C. G. et ne presentérent d’altérations dignes de note; 9- Comparativement à l’efficacité et toxicité connuesdes antimoniauxusuels, le TWSb, conservant une toxicité passagère et peu grave, présente une avantage manifeste, surtout pour son efficacité court (3-5 jours). Les effects secondaires, a notre avis, mériteraient encore des recherches pour aboutir à son elimination. Sa reduction substancielle augmentera son utilité thérapeutique.
1-67 patients divided in three groups of an endemic area of schistosomiasis were treated by TWSb (antimony dimercapto-succinate) in 10% solution in destiled water or physiologic serum: a)The period of treatment was 5 days in 21 patients, 4 days in 8 cases and 3 in 38; b)Intravenous application was used in 7 patients, intramuscular in 57 and both in 3; c)The average total dosage was 0,050g/Kg, using as minimum and maximum respectively: 1st group – 1,25 to 2,1g; 2nd. Group – 0,80 to 1,3g; and 3rd. group – a standard dose of 1,2g in 38 patients, without regarding the patient’s weight, and 1,6g in the remaining 5; 2- The majority of the patients had other common parasitosis and all ancylostomiasis. They were in wards in order to avoid reinfection and, in the last group, treatment was made in the usual field conditions where the patients were met; 3- Regular control as performed, examining viable ova of S. haematobium in the urine, immediately after treatment and weekly, forthnightly and monthly examinations. The control periods for each group of patients were between 68 and 132, 118 and 62 days; 4- In 65 patients, after a control period between 62 and 132 days after the beginning of treatment, 97 per cent of immediate cures were obtained; 5- In two patients of the 1st. group, two relapses were registered, respectively at the 40th day after the beginning of the treatment with a total dosage of 1,25g and at the 61st. day after a total dosage of 1,60g. Relapses were considered when viable ova reappeared in urine. In 3 patients of the 2nd group those who have received lower doses (0,8, 0,9 and 1,1g) ova were found at the 68th day, which, in contact with water, discharged miracides. However, at the 118th day, a new examination was negative; 6- Taking in to account all side-effects as reaction to TWSb, these showed a high percentage (75%). The main were gastro-intestinal disturbances (vomiting alone or associated with nausea and abdominal pains). In the great majority of patients these reaction were only after one injection, repeated or not, during the next, but not disturbing very much the patient. They should be considered transitory and not important complaints, they do not oblige the interruption of the treatment and subsided within two or three days after completion of treatment. It was apparent that the intravenous route and the greater dosage administered were more toxic. Only 4 patients (6% of the total), showed serious reactions (particularly vomiting), one of whom developed a syncopal stage with de-hidratation requiring urgent therapy; 7- The factors influencing these side-effects should be attributed to the presence of other parasitosis as ancylostomiasis and poor general condition of patients, which normaly occurred in the tropical rural areas. In fact, vomiting was more frequent in the last group of patients with a standard dosage of 1,2g administered in three following days; 8- Routine hemograms, proteinemia, liver function test, arterial tension and E. C. G. made on some patients before and after treatment showed no significative alterations; 9- Compared with the known efficacity and intolerance of antimonials used against schistosomiasis, TWSb, keeping an appreciable toxicity but transitory and not serious, is useful during a very short period of treatment (3-5 days). Not withstanding, it is our opinion, that the occurrence of side-effects needs some more investigation with the object to eliminate them. Their appreciable reduction will confirm the usefulness of the drug to be used on a large scale.
1-Trois groupes de malades de bilharziose vésicale ont été seumis à un traitement au TWSb (dimercaptosuccinate d’antimoine) sous forme de solution à 10% dans l’eau ou sérum phisiologique: a)La durée du traitement aété de cinq jour en 21 malades, de quatre jour en 8 cas et de trois en 38; b)La void’administration esée a été intaveineuse en 7 malades intramusculaire en 57 et tous les deux en 3; c)Le dosage moyen total a été de 0,050g/Kg en utilisant comme doses minimum et maximum respectivement: dans le 1er. Groupe 1,25 et 2,1g; dans le 2ème. 0,80 et 1,3g; et dans 3 ème., on a utilize un dosage standard de 1,2g en 38 malades, sans calculer le poids des maladies, et 1,6g en 5; 2- La majorité des maladies étaient porteurs d’autres parasitoses communes des tropiques et avaient ancylostomiase. Ils ont été hospitalisés pour éviter des réinfections et, dans l dernier groupe de 38 malades, on a fait le traitement dans les conditions qui nousavons trové les malades dans les zones rurales; 3- Des controles reguliers, examinant des oeufs viables de S. haematobium dans lúrine, ont été fait, après la fin du traitement et avec des examens hebdomadaires, tous les quinze jours et mensuels. Les periodes de controles furent par chacun des groupes 68 et 132, 118 et 62 jours; 4- Dans un total de 67 malades, après une période d’observation 62 et 132 jours après le début du traitement, on a vérifié un pourcentage de guérisons immédiates de 97 %.; 5- En 2 malades du 1er. Groupe on a enregistré deux rechutes (réaparition des oeufs viables dans l’urine) respectivement au 40 ème. et 61 éme. jours apr´`es le début du traitement, avec des doses totales de 1,25g et 1,6g. En 3 malades du 2ème. groupe, ceux qui ont reçu les doses les plus faibles (0,8, 0,9 et 1,1g) on trouvé au 68 éme. jour des oeufs dans l’urine qui, en contact avec l’eau, ont liberté des miracides. Mais un nouveau examen au 118 ème. jour a été négatif; 6- Dans l’ensemble, les effects sécondoires du TWSb ont été observes dans un grand pourcentage de maladies (75%), mais ils se bornèrent à des vomissements accompagnés de nausées ou douleurs abdominales dans la grande majorité des malades, seulement des vomissements aprés une injection, qui pourraient se r´péter dans les suivantes. Ils ont été bénins et passagers, sans affecter sérieusement les maladies, n’obligèrent pas l’interruption du traitement et ne laissèrent des sequelles. La voie intraveineuse et les dosages plus élevés ont été plus toxiques. Il est à remarquer que seulement en 4 malades (6% de l’ensemble) on a observe des effects sécondaires peu sérieux, particulièrement des vomissements; un malade a eu un état syncopal; 7- Bien qu’il soit dificille de se prononcer, peut être que les effects secondaires soient dus à la présence d’autres parasitoses, particulièrement l’ancylostomiase ou malnutrition, conditions qui sont habituelles parmi les populations des tropiques. En effect, les vomissements ont été becaucoup plus remarques dans le dernier groupe de maladies, dans lesquels une dose standard de 1,2g a été administrée en trois jours; 8- D’autres determinations ont été faites en quelques maladies: quadre hématologique, proteinémie, preuves du timol et Hanger, tension artériel et E. C. G. et ne presentérent d’altérations dignes de note; 9- Comparativement à l’efficacité et toxicité connuesdes antimoniauxusuels, le TWSb, conservant une toxicité passagère et peu grave, présente une avantage manifeste, surtout pour son efficacité court (3-5 jours). Les effects secondaires, a notre avis, mériteraient encore des recherches pour aboutir à son elimination. Sa reduction substancielle augmentera son utilité thérapeutique.
1-67 patients divided in three groups of an endemic area of schistosomiasis were treated by TWSb (antimony dimercapto-succinate) in 10% solution in destiled water or physiologic serum: a)The period of treatment was 5 days in 21 patients, 4 days in 8 cases and 3 in 38; b)Intravenous application was used in 7 patients, intramuscular in 57 and both in 3; c)The average total dosage was 0,050g/Kg, using as minimum and maximum respectively: 1st group – 1,25 to 2,1g; 2nd. Group – 0,80 to 1,3g; and 3rd. group – a standard dose of 1,2g in 38 patients, without regarding the patient’s weight, and 1,6g in the remaining 5; 2- The majority of the patients had other common parasitosis and all ancylostomiasis. They were in wards in order to avoid reinfection and, in the last group, treatment was made in the usual field conditions where the patients were met; 3- Regular control as performed, examining viable ova of S. haematobium in the urine, immediately after treatment and weekly, forthnightly and monthly examinations. The control periods for each group of patients were between 68 and 132, 118 and 62 days; 4- In 65 patients, after a control period between 62 and 132 days after the beginning of treatment, 97 per cent of immediate cures were obtained; 5- In two patients of the 1st. group, two relapses were registered, respectively at the 40th day after the beginning of the treatment with a total dosage of 1,25g and at the 61st. day after a total dosage of 1,60g. Relapses were considered when viable ova reappeared in urine. In 3 patients of the 2nd group those who have received lower doses (0,8, 0,9 and 1,1g) ova were found at the 68th day, which, in contact with water, discharged miracides. However, at the 118th day, a new examination was negative; 6- Taking in to account all side-effects as reaction to TWSb, these showed a high percentage (75%). The main were gastro-intestinal disturbances (vomiting alone or associated with nausea and abdominal pains). In the great majority of patients these reaction were only after one injection, repeated or not, during the next, but not disturbing very much the patient. They should be considered transitory and not important complaints, they do not oblige the interruption of the treatment and subsided within two or three days after completion of treatment. It was apparent that the intravenous route and the greater dosage administered were more toxic. Only 4 patients (6% of the total), showed serious reactions (particularly vomiting), one of whom developed a syncopal stage with de-hidratation requiring urgent therapy; 7- The factors influencing these side-effects should be attributed to the presence of other parasitosis as ancylostomiasis and poor general condition of patients, which normaly occurred in the tropical rural areas. In fact, vomiting was more frequent in the last group of patients with a standard dosage of 1,2g administered in three following days; 8- Routine hemograms, proteinemia, liver function test, arterial tension and E. C. G. made on some patients before and after treatment showed no significative alterations; 9- Compared with the known efficacity and intolerance of antimonials used against schistosomiasis, TWSb, keeping an appreciable toxicity but transitory and not serious, is useful during a very short period of treatment (3-5 days). Not withstanding, it is our opinion, that the occurrence of side-effects needs some more investigation with the object to eliminate them. Their appreciable reduction will confirm the usefulness of the drug to be used on a large scale.
Descrição
Contém quadros
Palavras-chave
Saúde pública Tratamento Bilharzíase Hospital Lisboa Luanda Guiné
Contexto Educativo
Citação
Oliveira, C. F., et al. (1960). Ensaios terapêuticos com o TWSb (Dimercaptossuccinato de Antimónio) na bilharzíase vesical: I- resultados obtidos na enfermaria escolar (Hospital do Ultramar) em Lisboa: II- resultados obtidos no Hospital de S. Paulo de Luanda: III- resultados obtidos na Guiné na enfermaria da missão de endemias . Anais do Instituto de Medicina Tropical: Instituto de Medicina Tropical, Lisboa, vol. 17, n.º 3, p. 669-696
Editora
Instituto de Medicina Tropical