Cutaneous leishmaniasis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
The evidence for optimal treatment of cutaneous leishmaniasis is patchy. Treatments that work for one species of leishmania may not work for another; it is recommended that advice of a tropical medicine or geographical medicine specialist be sought. Ideally, every effort should be made to establish the species of leishmania by molecular techniques (PCR) prior to starting treatment. In the setting of a developing country, there is often only one species present in a particular locality, so it is usually unnecessary to speciate every infection. Unfortunately, leishmaniasis is an orphan disease, and almost all the current treatment options are toxic with significant side-effects.
Leishmania major
- Treatment of L. major infections are usually considered to heal spontanously and do not require treatment, but there have been several reports of severe cases caused by L. major in Afghanistan. In Saudi Arabia, a six week course of oral fluconazole 200mg daily has been reported to speed up healing.[1]
Leishmania (Vianna) braziliensis
- Treatment with pentavalent antimonials or amphotericin is mandatory, because of the risk of developing disfiguring mucocutaneous lesions.
Leishmania infantum
- L. infantum is considered to be a rare cause of cutaneous leishmaniasis.
New treatment option are arising from the new oral drug Miltefosine (Impavido®) which has shown in several clinical trial to be very efficient and safe in visceral and cutanous leishmaniasis. Recent studies from Boliva show a high cure rate for mucocutaneous leishmaniasis. First comperative studies versus pentavalent antimonials in Iran and Pakistan show also a high cure rate for L.major and L.tropica. It is registered in many countries of Latin America (e.g. Colombia) as well in Germany, the home country of the originator Zentaris GmbH. In October 2006 it received orphan drug status from the US Food and Drug administration. The drug is generally better tolerated than other drugs. Main side effects are gastrointetinal disturbance in the 1-2 days of treatment which does not affect the efficacy.
Secondary bacterial infection (especially with Staphylococcus aureus) is common and may require antibiotics. Unfortunately, clinicians who are unfamiliar with cutaneous leishmaniasis may mistake the lesion for a pure bacterial infection (especially after isolation of S. aureus from bacterial skin swabs) and fail to consider the possibility of leishmaniasis.
References
- ↑ Alrajhi AA, Ibrahim EA, De Vol EB; et al. "Fluconazole for the treatment of cutaneous leishmaniasis caused byLeishmania major". N Engl J Med. 346 (12): 891&ndash, 95.