Report Leishmaniasis Explanation
Report Leishmaniasis Explanation
Report Leishmaniasis Explanation
Pathophysiology of Leishmaniasis
After inoculation by a sand fly, extracellular promastigotes are phagocytized by host
macrophages; inside these cells, they transform into amastigotes.
Pathophysiology of Leishmaniasis
After inoculation by a sand fly, extracellular promastigotes are phagocytized by host
macrophages; inside these cells, they transform into amastigotes.
The parasites may remain localized in the skin or spread to the mucosa of
the nasopharynx or disseminate to bone marrow, the spleen, the liver, and
occasionally other organs, resulting in 3 major clinical forms of leishmaniasis:
Cutaneous
Mucosal
Visceral
Treatment of Leishmaniasis
Drug therapy depends on the clinical syndrome and other factors
For cutaneous infection, topical treatment, sodium stibogluconate injection or
topical paromomycin outside the US or heat therapy or cryotherapy
For systemic treatment of cutaneous, mucosal, or visceral leishmaniasis,
liposomal amphotericin IV or miltefosine orally
Alternatively, amphotericin B deoxycholate IV or pentavalent antimonials
(sodium stibogluconate, meglumine antimoniate) IV or IM if the
infecting Leishmania species is likely to be susceptible
Treatment of leishmaniasis is complicated. The therapeutic approach depends on the
following:
Clinical syndrome
Infecting Leishmania species
Geographic location of acquisition
Organism's likelihood of susceptibility to antileishmanial drugs
Immune status of the host
Treatment references
Prevention of Leishmaniasis
For prevention of leishmaniasis, the following may help:
Key Points
Leishmaniasis is present in scattered areas worldwide and is
transmitted by bites of sand flies.
The parasites may remain localized in the skin (cutaneous
leishmaniasis), spread to the mucosa (mucosal leishmaniasis), or
disseminate to the liver, the spleen, and bone marrow (visceral
leishmaniasis).
Diagnose using Wright-Giemsa or Giemsa-stained smears,
cultures, or polymerase chain reaction-based assays; serologic
tests can help diagnose visceral leishmaniasis in
immunocompetent patients but are not helpful in many patients
with AIDS or with cutaneous or mucosal leishmaniasis.
Treat small, uncomplicated skin lesions with locally applied heat
or cryotherapy or, outside the US, with topical paromomycin or
intralesional sodium stibogluconate.
Systemic treatment options for complex cutaneous leishmaniasis,
mucosal leishmaniasis, and visceral leishmaniasis include
liposomal amphotericin B, miltefosine, and amphotericin
B deoxycholate; sodium stibogluconate or meglumine antimoniate
may be used if infection is acquired in areas where the
infecting Leishmania species is likely to be susceptible.
Drug resistance to antimonials is common in India and adjacent
countries and is emerging in other areas.