Termoterapia por radiofrequência: um tratamento alternativo para Leishmaniose cutânea no Amazonas

Abstract

In Brazil, American Tegumentary Leishmaniasis (LTA) stands out for its wide distribution, occurring in all states of the Federation. In 2015, 19,395 cases of the disease were reported, and the Amazon was responsible for 1,713, all in cutaneous form (SINAN, 2017). In the Amazon, the LTA is caused by seven species of leishmanias [Leishmania (Viannia) braziliensis, L. (V.) guyanensis, L. (V.) lainsoni, L. (V.) naiffi, L. (V.) shawi , L. (V.) lindenbergi and L. (Leishmania) amazonensis]. In Brazil, the Ministry of Health recommends as the first choice drug to be used in the Single Health System (SUS), pentavalent antimonial and pentamidine isethionate or amphotericin B as a second option and Pentoxifylline as immunomodulator. Some of these drugs have been used to treat Cutaneous Leishmaniasis (LC) for decades, yet they are toxic and require prolonged treatment duration. Moreover, parasites resistant to these drugs have emerged culminating in disease progression. Thermotherapy is an alternative treatment for LC, which consists of the spread of radiofrequency waves at a predetermined, localized temperature, applied to skin lesions to physically destroy the temperature-sensitive parasites and has been successfully used in the treatment for LC in others countries. This treatment provides precise and controlled location of heat to treat certain skin diseases selectively in the tissue. Abnormal and diseased cells are affected by heat and they undergo lysis, since the surrounding healthy cells are not affected because temperature is within a tolerable range. This is a low-cost, non-invasive protocol, in which there are still few studies related to its action in the different clinical forms of LTA that occur in Brazil, even less as regards its mechanism of action and immune response. Twelve patients treated with thermo-therapeutic protocol (ThermoMed Model 1.8) were followed for 12 months to evaluate clinical efficacy and 16 patients with LT, caused by Leishmania (Viannia) guyanensis, treated with meglumine antimoniate (Glucantine®). Patients with single or multiple lesions, both genders, 0.5 to 3.0 cm2 treated with thermotherapy received only a single application and achieved 58% clinical cure within two months. The Glucantime® group received cycles of (20 mg / kg / day) and at 3 months 100% of the patients presented resolution of the lesions with tissue re-epithelialization. Of the patients treated with Glucantime®, cytokine analysis was performed by flow cytometry techniques. The concentration of proinflammatory cytokines (IL-2, TNF-α, IFN-γ) showed significant differences (p <0.0001) between infected and uninfected individuals (control group). The thermotherapeutic treatment for LC is indicated as an alternative method because it has a lower cost and a reduced collateral effect, suggesting the continuity of studies that can clarify if there is a specific species response, thus directing the therapeutic indication of support to the conventional treatment.