Cutaneous Leishmaniasis: Recent Developments in Diagnosis and Management

Abstract

This review focuses on recent developments in the diagnosis, treatment, management, and strategies for the prevention and control of cutaneous leishmaniasis (CL) caused by both Old and New World Leishmania species. CL is caused by the vector-borne protozoan parasite Leishmania and is transmitted via infected female sandflies. The disease is endemic in more than 98 countries and an estimated 350 million people are at risk. The overall prevalence is 12 million cases and the annual incidence is 2–2.5 million. The World Health Organization considers CL a severely neglected disease and a category 1 emerging and uncontrolled disease. The management of CL differs from region to region and is primarily based on local experience-based evidence. Most CL patients can be treated with topical treatments, but some Leishmania species can cause mucocutaneous involvement requiring a systemic therapeutic approach. Moreover, Leishmania species can vary in their sensitivity to available therapeutic options. This makes species determination critical for the choice of treatment and the clinical outcome of CL. Identification of the infecting parasite used to be laborious, but now the Leishmania species can be identified relatively easy with new DNA techniques that enable a more rational therapy choice. Current treatment guidelines for CL are based on poorly designed and reported trials. There is a lack of evidence for potentially beneficial treatments, a desperate need for large well-conducted studies, and standardization of future trials. Moreover, intensified research programs to improve vector control, diagnostics, and the therapeutic arsenal to contain further incidence and morbidity are needed.

Determination the Role of Rhipicephalus sanguineus for Transmission of Leishmania major to Reservoir Animals

“…Leishmaniasis 350 milyon insanın risk altında olduğu 90'dan fazla ülkede endemik olan, tedavi edilmezse %100'e varan oranda ölümle sonuçlanabilen zoonoz karakterli bir hastalıktır (5,9,24). Hastalık dünyanın pek çok yerinde visseral leishmaniasis (VL), kutanöz leishmaniasis (KL), diffuz deri leishmaniasis (DKL) ve mukokutanöz leishmaniasis (MKL) gibi değişik formları görülmesine rağmen (3), Türkiye'de şimdiye kadar VL, KL ve köpek visseral leishmaniasis (KVL) formları görülmüştür (25).…”

Therapeutic Options of Cutaneous Leishmaniasis

“…After a bite, the lesions occur as inflammatory erythematous papules which further develop to nodules and crust in the center of the lesion [4,9,10]. The lesions are painless and heal spontaneously after several months or are characterized by function impairment, susceptibility to secondary infection, and development of disfiguring permanent scars [5,11,12]. In addition, the site, severity and extent of cutaneous disease as well as time to spontaneous resolution can affect on healing process.…”

“…In addition, in many settings species identification is unavailable or impossible and local expertise is the only mode of therapy which is associated with significant toxicity and side effects. Therefore, the aim of therapy is to reduce the risk of dissemination and relapse, speed disease resolution and minimize scarring and on the other hand, improve reepithelialization of the ulcerative lesions and resolution of popular or nodular lesions [11,12].…”

“…Although antimonials are considered as the mainstay of treatment of CL, they are limited by systemic side effects, local pain during intramuscular injections, development of drug resistance, and high price in developing countries [12,15]. The alternative treatment regimens include miltefosine, pentamidine isethionate, amphotericin B, antifungal agents (e.g., ketoconazole, fluconazole, itraconazol), paromomycine, and granulocyte macrophage colony-stimulating factor [11]. Pentamidine is an alternative agent to antimonials in the management of CL and from the other side have adverse effects such as hypoglycemia, hypotension, nausea, vomiting, dizziness, myalgia, headache, syncope, transient hyperglycemia and pain at the injection site [12,16,17].…”

“…Another important finding is the fact that L. mexicana has been found resistance to miltefosine and antimony is preferred in systemic treatment [21,22]. Likewise in CL caused by L. panamensis or L. amazonensis which rarely cause MCL, combination of local therapy of antimony and cryotherapy is preferable than systemic therapy [11]. Moreover, since monotherapy causes a growing resistance of the parasite to antileishmanial drugs, multidrug therapy can lead to short duration of therapy, low dose requirement, reduce chances of toxic side effects and cost, and prevent the emergence of drug resistance.…”