Therapy of vector-borne protozoan infections in nonendemic settings

Abstract

Vector-borne protozoan infections are responsible for a wide variety of illnesses (mainly malaria, trypanosomiasis and leishmaniasis) affecting tropical and subtropical areas, but increasingly diagnosed in nonendemic settings. This article summarizes the therapeutic developments for these conditions during the past decade and focuses specifically on treatment recommendations for returning travelers and migrants. The treatment of malaria has known the most spectacular improvements. Progress in the management of leishmaniasis and trypanosomiasis has also been substantial and includes introduction of new drugs into clinical practice, combinations of existing drugs, or new laboratory tools for treatment monitoring as well as extension of treatment indications to new groups of patients. Serious gaps still exist in terms of effectiveness and tolerance. Since the research pipeline is very limited for the coming 5-10 years, optimized combinations of existing drugs need to be urgently explored.

Stress Management in Cyst-Forming Free-Living Protists: Programmed Cell Death and/or Encystment

“…This group of parasites includes Plasmodium spp., Trypanosoma spp., Leishmania spp., Babesia spp., and Trichomonas vaginalis , which produce serious human infections [ 2 – 4 ]. Although Plasmodium can make themselves oocyst, a survival form against harsh environments, they are not viable in the environment and are for simplicity described as non-cyst-forming parasitic protists.…”

Tropical parasitic diseases and immunosuppression

“…In addition to representing a long-lasting burden in tropical countries, in recent decades these conditions have become a challenge for clinicians in non-endemic settings, as a result of increasing travel and migration [4][5][6]. Finally, the increasing number of immunocompromised individuals in tropical environments-international travellers or local populations of emerging economies with immunosuppressive conditions or treatment-makes the global picture even more complex [7,8].…”

Killing the Dead: Chemotherapeutic Strategies Against Free‐Living Cyst‐Forming Protists (Acanthamoeba sp. and Balamuthia mandrillaris)

“…The noncyst‐forming parasitic protists include Plasmodium spp., Trypanosoma spp., Leishmania spp., that collectively kill millions of people, annually, despite our advances in antimicrobial chemotherapy and supportive care, while Babesia spp., Trichomonas vaginalis produce serious human infections (Bottieau et al. ; Khan ). In general, the inability of this group of organisms to form a cyst means that they cannot survive in the environment and must reside inside a host at all times, be that a human or an insect.…”