Marcos Olivicr Dalston; Walter Tavares; Ana Ricordi Bazin; Miriam Dumas Hahn; Alair Augusto S. Damas dos Santos; Teimo Pimentel; Jurema Nunes Mello
RESUMO
Os autores relatam a resposta terapêutica da claritromicina associada com pirímetamina em dois casos de toxoplasmose cerebral ocorridos em pacientes com Síndrome de Imunodeficiência Adquirida (SIDA). Nos dois casos o diagnóstico foi presuntivo, baseando-se nas manifestações clínicas e na presença de lesões expansivas hipercaptantes detectadas na tomografia computadorizada (TC) de crânio. Em ambos os casos, observou-se exantema com o uso da sulfadiazina e da clindamicina, razão pela qual tais medicamentos foram substituídos pela claritromicina (1,5 a 2g/dia) associada à pirímetamina (25mg/dia). A resposta terapêutica foi favorável nos dois casos com melhora das manifestações neurológicas e dos achados neurorradiológicos. Os autores sugerem que a associação claritromicina com pirímetamina pode ser útil como opção terapêutica na toxoplasmose cerebral em pacientes com SIDA que apresentam intolerância ou outra contra-indicação ao emprego das sulfonamidas.
Palavras-chave: Claritromicina. Toxoplasmose cerebral. SIDA.
ABSTRACT
The authors report the use and tbe outcome of claritromycin associated with pyrimethamine in the treatment of toxoplasma encephalites in two patients with AIDS. Both patients had the diagnosis stablished on clinical grounds, positive sorology (IgG) for toxoplasmosis and computed-tomographic (CT) scan of the brain showing lesions consistent with T. gondii encephalitis. The two patients were initially treated with pyrimethamine and sulfadiazme, which was changed to clindamycin due to allergic reactions. These reactions (skin rash) occurred with clindamycin as well and the patients were treated with claritromycin and pyrimethamine. The scheduled regimens were 1.5 to 2g of clarithromycin plus 25mg of pyrimethamine. The clinical response was very good in both cases with regression of neurologic signs and encephalitic abnormalities observed on CT scan. The authors suggest that clarithromycin associated with pyrimethamine may be an alternative treatment for toxoplasmosis in AIDS patients, who cannot receive or tolerate sulfa treatment.
Keyworks: Clarithromycin. Cerebral toxoplasmosis. AIDS.
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Recebido para publicação em 07/11/94.
Disciplina de Doenças Infecciosas e Parasitárias do Hospital Universitário Antonio Pedro e Departamento de Medicina Clínica, Faculdade de Medicina da Universidade Federal Fluminense, Niterói, RJ.
Endereço para correspondência:
Dr. Marcos Olivier Dalston
R. Luiz Erthal 31, Qadra 68, Piratininga, 24350-050
Niterói, RJ.
