How is mucocutaneous leishmaniasis treated?

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

Mucocutaneous disease responds to a 20-day course of sodium antimony gluconate; amphotericin B may be used to treat advanced or resistant cases. Pentavalent antimony for a course of 4 weeks has also been recommended.

A single arm study in adults conducted to evaluate oral miltefosine efficacy for the treatment of mucocutaneous leishmaniasis showed that by 12 months after the end of therapy, 62% of patients had complete resolution of edema, erythema, infiltration, and erosion from the involved mucosal sites. [37] The study was conducted in Bolivia, where L braziliensis is epidemiologically the prevalent species.

The protective effect against subsequent mucocutaneous disease is unknown at this time. One study showed a 1-year cure rate of 75% among Bolivian patients who presented with mild mucocutaneous leishmaniasis. The particular strain of L (Viannia) braziliensis affected an area known to have antimonial resistance. One-year cure rates were lower among patients with more severe disease. Long-term studies will be required to determine if a definitive cure was achieved.


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