What are the approach considerations in the timing of treatment of leishmaniasis?

Updated: Feb 18, 2020
  • Author: Craig G Stark, MD, FACP, FFTM, RCPS(Glasg), FISTM; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Given the associated morbidity, always treat visceral, mucocutaneous, and severe forms of cutaneous leishmaniasis. Patients should receive treatment at facilities experienced in treating the disease as per latest guidelines.

Owing to its potential to progress into mucocutaneous leishmaniasis, definitively treat New World cutaneous leishmaniasis caused by members of the Leishmania Viannia subgenus. Cases due to L tropica (Old World) and some L major from certain regions of Afghanistan may have a more aggressive or chronic course (up to years); L tropica has been implicated in occasional cases of recidivans or viscerotropic leishmaniasis. As such, treatment may need to be more involved in cases caused by this species.

In New World leishmaniasis, estimates of recurrence range from less than 5% to as many as 10% of untreated individuals experiencing chronic ulcers, recidivans lesions, or mucocutaneous involvement. Because of this, treatment is very often the standard of care, and parenteral therapy is usually the treatment of choice.

New World cutaneous leishmaniasis due to L mexicana is not associated with mucocutaneous leishmaniasis and may not require systemic treatment. Cutaneous leishmaniasis acquired in the Old World tends to resolve spontaneously (eg, L major from Iraq), but patients with this infection should receive treatment if the lesions are disfiguring, painful, infected, over joints, or slow to heal.


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