XI International Meeting on Paracoccidioidomycosis

XI International Meeting on Paracoccidioidomycosis

Resume:44-1

Poster (Painel)

44-1

Evaluation of renal and liver blood chemistry before and in the follow-up of paracoccidioidomycosis-patients treated with cotrimoxazole or itraconazole.

Authors:

Adriele Dandara Levorato (FMB - UNESP - Faculdade de Medicina de Botucatu) ; Daniela Vanessa Moris (FMB - UNESP - Faculdade de Medicina de Botucatu) ; Tatiane Fernanda Sylvestre (FMB - UNESP - Faculdade de Medicina de Botucatu) ; Ricardo de Souza Cavalcante (FMB - UNESP - Faculdade de Medicina de Botucatu) ; Lídia Raquel Carvalho (IBB - UNESP - Instituto de Biociência) ; Rinaldo Poncio Mendes (FMB - UNESP - Faculdade de Medicina de Botucatu)

Abstract

Introduction. Patients infected by Paracoccidioides brasiliensis, an eukaryote organism, are treated with itraconazole (ITC) or cotrimoxazole-CMX. Adverse effects on kidneys and liver should be evaluated during therapy and were the aims of this study. Patients and Methods. Forty-seven patients with confirmed paracoccidioidomycosis were studied, eight with the acute/subacute form-AF and 39 with the chronic form-CF. Eight cases were treated with ITC and 39 with CMX. Aminotransferases-ALT and AST, alkaline phosphatase-AP, &gamma- glutamil transferase-&gammaGT, total bilirrubin-TB, direct bilirrubin-DB, urea nitrogen-UN, creatinine, sodium, and potassium serum levels were evaluated at the Hospital Laboratory. PCM-p were evaluated at different moments: M1-before treatment; moments 2 (M2), 3 (M3) and 4 (M4): 4-6 weeks, 7-10 and 11-14 weeks after the beginning of the treatment. Comparison of groups was carried out by analysis of variance; to compare clinical forms at different periods or clinical forms and antifungal compounds the profile analysis of variance was used. Significance was set at p&le0.05. Results. 1. Pre-treatment (M1): 1a) TB levels showed CF>AF (p=0.001), although both averages were normal; 1b) AP levels were increase AF&geCF (p= 0.07); 1c) ALT (TGP) levels revealed CF>AF (p=0.04), within the normal range. 2. Effects of the therapy: 2a) at M2 potassium levels showed CF>AF (p=0.04), within the normal range; 2b) AP tended to normalize in the AF during the treatment (p=0.07); 2c) &gammaGT levels decreased after treatment (p=0.04) in the AF; 3. Comparisons between groups as to antifungal compound: 3a) potassium levels were higher in patients CMX-treated at M3 (p=0.01); 3b) TB levels showed ITC&geCMX (p=0.06) at M3; 3c) DB (p=0.005), at M2 and BUN (p=0.04), at M1 levels were higher in ITC-patients. Conclusions. Changes in renal and liver blood chemistry were observed and may be important markers for the prognosis and therapeutic follow-up of PCM cases. Clinical forms showed small differences as to antifungal side effects. Altered renal function and mild ITC-induced hepatotoxicity were few times observed, confirming the safety of these antifungal compounds.

Keyword: Adverse effects, Cotrimoxazole, Itraconazole, Paracoccidioides brasiliensis, Paracoccidioidomycosis

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