Medication
Treatment of cutaneous leishmaniasis may be indicated to:
- Decrease the risk for mucosal dissemination/disease (particularly for New World species in the Viannia subgenus; see Disease );
- Accelerate the healing of the skin lesions;
- Decrease the risk for relapse (clinical reactivation) of the skin lesions;
Nutrition
Treatment decisions should be individualized, with expert consultation. In general, all clinically manifest cases of visceral leishmaniasis and mucosal leishmaniasis should be treated, whereas not all cases of cutaneous leishmaniasis require treatment. The treatment approach depends in part on host and parasite factors.
How is leishmaniasis treated?
What are the types of leishmaniasis?
- Cutaneous leishmaniasis. Cutaneous leishmaniasis causes ulcers on your skin. ...
- Mucocutaneous leishmaniasis. A rare form of the disease, mucocutaneous leishmaniasis is caused by the cutaneous form of the parasite and can occur several months after skin ulcers heal.
- Visceral leishmaniasis. ...
How to treat leishmaniasis?
Visceral leishmaniasis, the most severe form of leishmaniasis also known as kala-azar, is a life-threatening disease caused by Leishmania parasites which are transmitted by female sandflies. Visceral leishmaniasis causes fever, weight loss, spleen and liver enlargement, and, if not treated, death.
What is leishmaniasis disease treatment?
What is the prognosis of visceral leishmaniasis?
What is the drug of choice for treatment of leishmaniasis?
Sodium stibogluconate (Pentostam) Sodium stibogluconate has been the drug of choice for the treatment of cutaneous and mucocutaneous leishmaniasis in the United States. This agent is also effective against visceral leishmaniasis and is often the first-line treatment outside the United States.
Is cutaneous leishmaniasis curable?
Leishmaniasis is a treatable and curable disease, which requires an immunocompetent system because medicines will not get rid of the parasite from the body, thus the risk of relapse if immunosuppression occurs. All patients diagnosed as with visceral leishmaniasis require prompt and complete treatment.
Is leishmaniasis treated with antibiotics?
Pentamidine is a first-line medication in cutaneous leishmaniasis except for L mexicana (ketoconazole 600 mg PO qd for 28 days). It is a treatment alternative in visceral leishmaniasis. Available antibiotic preparations include pentamidine isethionate (Pentam) and pentamidine dimethanesulfonate (Lomidine).
What is used in treatment of kala-azar?
The aim of treatment in kala-azar is killing of the parasite with effective drugs which are cheap and less toxic. Pentavalent antimonials are the first line drugs and pentamidine and amphotericin B are the second line drugs. Recently the latter are being used as first line drugs also [12].
What is the treatment for leishmaniasis in dogs?
The most effective treatment of CL in dogs involves injections of pentavalent antimonial, meglumine antimonite in combination with allopurinol, which is required to be administered for 6–12 months to prevent the relapses of the infection.
Is there a vaccine for leishmaniasis?
Currently there are no available vaccines against any form of human leishmaniasis. Unlike most parasitic infections, patients who recover from leishmaniasis naturally or following drug treatment develop immunity against reinfection indicating that the development of an effective vaccine should be feasible6,7,8.
Is cutaneous leishmaniasis painful?
Cutaneous leishmaniasis. These sores can begin as bumps (papules) or lumps (nodules) and may eventually turn into ulcers covered by crust or scab. These sores are typically painless but can also be painful, accompanied by swollen glands. It may also take months or years to heal from the sores, which can leave scars.
How is cutaneous leishmaniasis diagnosed?
In the United States, CDC staff can assist with the testing for leishmaniasis. Tissue specimens—such as from skin sores (for cutaneous leishmaniasis) or from bone marrow (for visceral leishmaniasis)—can be examined for the parasite under a microscope, in special cultures, and by molecular tests.
What are Antimonial drugs?
Antimonials, in pre-modern medicine, were remedies principally containing antimony, used chiefly for emetic purposes. They might also have qualified for cathartic, diaphoretic, or simply alternative uses. Such treatments were considered unparalleled in their strength.
Why Amphotericin B is given in kala-azar?
Amphotericin B deoxycholate has been used in India for treatment of visceral leishmaniasis (kala-azar) for >1 decade. Its rediscovery as effective treatment for Leishmania donovani infection was spawned by the development of large-scale resistance to conventional pentavalent antimony therapy in Bihar State [1].
What are the symptoms of cutaneous leishmaniasis?
Symptoms of cutaneous leishmaniasis depend on where the lesions are located and may include:Breathing difficulty.Skin sores, which may become a skin ulcer that heals very slowly.Stuffy nose, runny nose, and nosebleeds.Swallowing difficulty.More items...•
What causes cutaneous leishmaniasis?
Leishmaniasis is a parasitic disease that is found in parts of the tropics, subtropics, and southern Europe. Leishmaniasis is caused by infection with Leishmania parasites, which are spread by the bite of infected sand flies. There are several different forms of leishmaniasis in people.
What is the treatment for leishmania?
Many drugs are used for its treatment, and a current effective one is a pentavalent antimonial, especially in developing countries. In this review, we discuss recent proposed therapies as well as their side effects.
What is the best antibiotic for leishmania?
Amphotericin B. Amphotericin B (AmB) is a macrolide polyene antibiotic with potent antifungal and anti-leishmanial activity that targets ergosterol, the principal membrane component of Leishmaniaspp.37,38. It is considered a second-line treatment for CL. There are four formulations of AmB: one is amphotericin B deoxycholate, and the rest are lipid formulations of the drug, liposomal amphotericin, cholesterol dispersion amphotericin, and lipid complex amphotericin2,8,37. The three lipid formulations were made to minimize adverse events such as nephrotoxicity reported with amphotericin B deoxycholate; however, the only drug of this type approved by the US Food and Drug Administration (FDA) is liposomal amphotericin B (L-AmB)8. L-AmB has an efficacy of 95–100% in visceral leishmaniasis39. However, there are a few studies of CL treatment with L-AmB, and they show big differences in the reported cure rates and the total doses used8. A review of L-AmB treatment of OWCL reported that L-AmB had an 85% cure rate in immunocompetent patients with OWCL but also found a high variety of total treatment dosages, which limits the reported data, so the authors concluded that there is a need for randomized controlled trials comparing systemic treatments39.
What is the disease caused by a sandfly?
Leishmaniasis is a neglected tropical disease caused by species of Leishmaniaand transmitted to humans by the bite of a sandfly, mainly Phlebotomusand Lutzomyia(Old World and New World, respectively)1. It is a major public health problem with a broad spectrum of clinical manifestations and epidemiological diversity with different degrees of severity that depend on the involved intracellular parasiteand the immune response of the host. It has a wide distribution and is endemic in circumscribed areas in Northeastern Africa, Southern Europe, the Middle East, Mexico, and Central and South America1. In its treatment, many drugs are used, but around 50% of satisfactory clinical and microbiological results for almost all clinical forms are achieved with a current pentavalent antimonial. This review evaluates recently proposed treatments and their side effects.
What is local therapy?
Local therapies have been recommended by the World Health Organization (WHO), the Pan American Health Organization (PAHO), and other experts as an alternative to systemic drugs in patients with at least four lesions smaller than 4 cm in diameter, especially when the face or joints are not affected. Usually, they are easy to use and have a lower risk, toxicity, and cost compared to traditional therapies. Local treatment includes thermotherapy, cryotherapy, and topical and intralesional drugs. The last approach is effective and safe in localized forms2–4.
What are the advantages of azole for Leishmania?
Important advantages of azoles are oral administration and fewer side effects28 . A systematic review and meta-analysis which included studies involving outcomes showed a pooled azole final efficacy rate of 64% for the treatment of CL, finding a higher healing rate in Leishmania mexicana(89%), Leishmania infantum(88%), and Leishmania donovani(80%) and lower cure rates for Leishmania major(53%), Leishmania braziliensis(49%), and Leishmania tropica(15%)35. A randomized controlled trial in India compared oral itraconazole 200 mg/day for 6 weeks versus no treatment and showed complete cure in 66.7% of the itraconazole group and none of the placebo group18. In Italy, pediatric patients with OWCL were treated with fluconazole at a dose of 6 mg/kg daily for 6 weeks and exhibited complete cure36. Long-term treatment with azoles have toxicity risks, such as hepatotoxicity and QTc prolongations, which is why the recommended dosage of fluconazole is 200 mg or 400 mg daily for 6 weeks, ketoconazole 600 mg daily for 28 days, and itraconazole 100 mg twice daily for 42–56 days3.
What is pentamidine isethionate used for?
It is exclusively used for L. guyanensis. The recommended dose is 4 mg/kg/day on alternate days (maximum dose of 240 mg/day)3,8. Christen et al. reported a higher efficacy of the intravenous administration of pentamidine isethionate (85.3%) versus intramuscular administration (51.3%) in L. guyanensisCL43. However, it is generally used as a second-line treatment owing to nephrotoxicity, hepatotoxicity, pancreatitis leading to insulin-dependent diabetes , hypertension, hypoglycemia, QT prolongation, hyperkalemia, and vertigo1,3,8.
What is the best laser for CL24?
Erbium glass laser . Mashayekhi et al. reported the use of erbium glass laser for the treatment of CL24. The study was conducted in Iran, and the authors treated 14 patients with 20 lesions of Old World CL (OWCL) using erbium glass laser 1540 nm weekly (10 mm spot size handpiece with 10 ms pulse duration and 50–70 mJ/cm2fluence in four passes). Only nine patients with 12 lesions ended the protocol, and 91.66% of the lesions improved completely at 6 weeks of treatment. The side effects reported were pain during the procedure, erythema, and edema. The authors concluded that it may be a promising method for the treatment of CL24.
What is the treatment for cutaneous leishmaniasis?
The causative species of cutaneous leishmaniasis determines the clinical features and courses, and treatments. Intralesional or systemic antimonials are the gold standard for the treatment of these diseases. However, as for visceral leishmaniasis, other therapeutic options appear promising. Paromomy …
What is the best treatment for leishmania?
The causative species of cutaneous leishmaniasis determines the clinical features and courses, and treatments. Intralesional or systemic antimonials are the gold standard for the treatment of these diseases. However, as for visceral leishmaniasis, other therapeutic options appear promising. Paromomycin ointments are effective in Leishmania major, L. tropica, L. mexicana, and L. panamensis lesions. In L. braziliensis localized leishmaniasis, both paromomycin and imiquimod may be topically applied. Oral fluconazole and zinc sulfate are useful in L. major. Oral azithromycin, effective in vitro and in mice, needs further investigation in human leishmaniasis. On the contrary, data with oral itraconazole are disappointing. Oral miltefosine, which is very effective in visceral leishmaniasis caused by L. donovani, appears ineffective in L. major and L. braziliensis infections. Intramuscular pentamidine is required for L. guyanensis cutaneous leishmaniasis, for which systemic antimony is not effective. Liposomal amphotericin B could be an alternative to antimony in south American cutaneous leishmaniasis with mucosal involvement (especially L. braziliensis and L. guyanensis infections).
