What long-term monitoring is indicated for patients with 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

Carefully monitor patients with leishmaniasis for relapse or recrudescence for up to 6 months after successful treatment.

Perform a follow-up evaluation for patients 6 weeks after last dose of pentavalent antimony. Drug-resistant strains of leishmaniasis are appearing because of the unregulated use of these compounds. Improper dosing and shortened duration of therapy are contributing factors. Improvement in cutaneous disease is expected within the first couple of weeks of treatment. Patients with visceral disease should defervesce around 72 hours, with resolution of hepatosplenomegaly by 28 days.

Severe leishmaniasis recidivans, mucocutaneous leishmaniasis, diffuse cutaneous leishmaniasis, and post–kala-azar leishmaniasis are often difficult to treat and may require prolonged therapy.

Retreatment or second-line drugs may be required in patients with resistant disease.

Prescribe hematinics until the patient’s hemoglobin levels return to within the reference range.


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