What are the management options for the 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

In general, if the case is not advanced with serious gastroenterologic, hematologic, or infectious issues, care can be accomplished on an outpatient basis. However, daily visits to a physician for medication may be required.

Multiple medical treatment options are used throughout the world for cutaneous disease. In addition to parenteral and oral medications (see Medication), local therapies for some forms of cutaneous leishmaniasis include (1) cryotherapy, (2) infiltration of sodium stibogluconate at 0.3-0.8 mL, (3) local heat therapy at 40-42°C, and (4) various topical paromomycin preparations, typically 15% with 10% urea.

Of primary importance in dealing with leishmaniasis is the treatment of malnutrition, concurrent systemic illness (eg, human immunodeficiency virus [HIV] infection, tuberculosis), or local infection (secondary bacterial). Malnourished individuals are at greater risk of acquiring leishmaniasis, have increase morbidity and mortality in mucocutaneous and visceral disease, and respond less well to treatment than those with adequate nutrition.

Other things to consider include the following:

  • At the onset of therapy, admit patients for laboratory and cardiac monitoring; alternate drug regimens require variable monitoring levels commensurate with their known adverse effects

  • Administer antibiotic therapy to treat superimposed bacterial wound infections, and consult an infectious disease specialist or a dermatologist for definitive diagnosis and treatment

  • Provide supportive care for patients with visceral and severe mucocutaneous leishmaniasis, as required; supportive treatment includes rest, a high-protein and high-calorie diet, blood transfusions, and wound care

  • The earliest sign of improvement is an improvement in symptoms; regression of splenomegaly takes a few months

Despite successful clinical outcomes, the question of whether the parasites are completely eradicated is unclear, because reactivation of leishmaniasis with immunosuppression has been reported. [26]


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