Abstract
The annual incidence of cutaneous and visceral leishmaniasis is at least two million people, with 350 million people in 98 countries at risk for acquiring infection. These are diseases mostly of the impoverished and are considered in the top five of neglected infectious diseases worldwide, making prevention, diagnosis, and treatment difficult. Therapy of leishmaniasis ranges from local treatment of cutaneous lesions to systemic, often toxic, therapy for disseminated cutaneous, mucocutaneous, and deadly visceral disease. This chapter discusses the current treatment regimens commonly used for various forms of leishmaniasis with attention to some promising newer experimental approaches.
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References
Alrajhi AA, Ibrahim EA, De Vol EB, Khairat M, Faris RM, Maguire JH (2002) Fluconazole for the treatment of cutaneous leishmaniasis caused by Leishmania major. N Engl J Med 346:891–895
Antinori S, Longhi E, Bestetti G, Piolini R, Acquaviva V, Foschi A et al (2007) Post-kala-azar dermal leishmaniasis as an immune reconstitution inflammatory syndrome in a patient with acquired immune deficiency syndrome. Br J Dermatol 157:1032–1036
Arana BA, Mendoza CE, Rizzo NR, Kroeger A (2001) Randomized, controlled, double-blind trial of topical treatment of cutaneous leishmaniasis with paromomycin plus methylbenzethonium chloride ointment in Guatemala. Am J Trop Med Hyg 65:466–470
Arevalo I, Ward B, Miller R, Meng TC, Najar E, Alvarez E et al (2001) Successful treatment of drug-resistant cutaneous leishmaniasis in humans by use of imiquimod, an immunomodulator. Clin Infect Dis 33:1847–1851
Arevalo I, Tulliano G, Quispe A, Spaeth G, Matlashewski G, Llanos-Cuentas A et al (2007) Role of imiquimod and parenteral meglumine antimoniate in the initial treatment of cutaneous leishmaniasis. Clin Infect Dis 44:1549–1554
Asilian A, Sadeghinia A, Faghihi G, Momeni A, Amini Harandi A (2003) The efficacy of treatment with intralesional meglumine antimoniate alone, compared with that of cryotherapy combined with the meglumine antimoniate or intralesional sodium stibogluconate, in the treatment of cutaneous leishmaniasis. Ann Trop Med Parasitol 97:493–498
Asilian A, Sadeghinia A, Faghihi G, Momeni A (2004) Comparative study of the efficacy of combined cryotherapy and intralesional meglumine antimoniate (Glucantime) vs. cryotherapy and intralesional meglumine antimoniate (Glucantime) alone for the treatment of cutaneous leishmaniasis. Int J Dermatol 43:281–283
Badaro R, Lobo I, Nakatani M, Muinos A, Netto EM, Coler RN et al (2001) Successful use of a defined antigen/GM-CSF adjuvant vaccine to treat mucosal Leishmaniasis refractory to antimony: a case report. Braz J Infect Dis 5:223–232
Badaro R, Lobo I, Munos A, Netto EM, Modabber F, Campos-Neto A et al (2006) Immunotherapy for drug-refractory mucosal leishmaniasis. J Infect Dis 194:1151–1159
Baiocco P, Colotti G, Franceschini S, Ilari A (2009) Molecular basis of antimony treatment in leishmaniasis. J Med Chem 52:2603–2612
Barratt G, Legrand P (2005) Comparison of the efficacy and pharmacology of formulations of amphotericin B used in treatment of leishmaniasis. Curr Opin Infect Dis 18:527–530
Ben Salah A, Ben Messaoud N, Guedri E, Zaatour A, Ben Alaya N, Bettaieb J et al (2013) Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med 368:524–532
Bringaud F, Riviere L, Coustou V (2006) Energy metabolism of trypanosomatids: adaptation to available carbon sources. Mol Biochem Parasitol 149:1–9
Bumb RA, Prasad N, Khandelwal K, Aara N, Mehta RD, Ghiya BC et al (2013) Long-term efficacy of a single-dose Radio Frequency Heat therapy versus intralesional antimonials for cutaneous leishmaniasis in India. Br J Dermatol 168(5):1114–1119
Calvopina M, Armijos RX, Hashiguchi Y (2004) Epidemiology of leishmaniasis in Ecuador: current status of knowledge—a review. Mem Inst Oswaldo Cruz 99:663–672
Center for Disease Control (1992) Viscerotropic leishmaniasis in persons returning from Operation Desert Storm—1990–1991. MMWR Morb Mortal Wkly Rep 41:131–134
Chang KP, Dwyer DM (1976) Multiplication of a human parasite (Leishmania donovani) in phagolysosomes of hamster macrophages in vitro. Science 193:678–680
Chang KP, Reed SG, McGwire BS, Soong L (2003) Leishmania model for microbial virulence: the relevance of parasite multiplication and pathoantigenicity. Acta Trop 85:375–390
Convit J, Ulrich M, Zerpa O, Borges R, Aranzazu N, Valera M et al (2003) Immunotherapy of American cutaneous leishmaniasis in Venezuela during the period 1990–99. Trans R Soc Trop Med Hyg 97:469–472
Convit J, Ulrich M, Polegre MA, Avila A, Rodriguez N, Mazzedo MI et al (2004) Therapy of Venezuelan patients with severe mucocutaneous or early lesions of diffuse cutaneous leishmaniasis with a vaccine containing pasteurized Leishmania promastigotes and bacillus Calmette-Guerin: preliminary report. Mem Inst Oswaldo Cruz 99:57–62
Cunningham ML, Beverley SM (2001) Pteridine salvage throughout the Leishmania infectious cycle: implications for antifolate chemotherapy. Mol Biochem Parasitol 113:199–213
Das BB, Sengupta T, Ganguly A, Majumder HK (2006) Topoisomerases of kinetoplastid parasites: why so fascinating? Mol Microbiol 62:917–927
David CV, Craft N (2009) Cutaneous and mucocutaneous leishmaniasis. Dermatol Ther 22:491–502
de Oliveira CI, Brodskyn CI (2012) The immunobiology of Leishmania braziliensis infection. Front Immunol 3:145
Esfandiarpour I, Dabiri SH (2007) Treatment of cutaneous leishmaniasis recidivans with a combination of allopurinol and meglumine antimoniate: a clinical and histologic study. Int J Dermatol 46:848–852
Expert Committee, Control of the leishmaniases. WHO Technical Report Series 949. World Health Organization, Geneva, Switzerland, 2010, pp 1–186
Fairlamb AH, Blackburn P, Ulrich P, Chait BT, Cerami A (1985) Trypanothione: a novel bis(glutathionyl)spermidine cofactor for glutathione reductase in trypanosomatids. Science 227:1485–1487
Fidalgo LM, Gille L (2011) Mitochondria and trypanosomatids: targets and drugs. Pharm Res 28:2758–2770
Firooz A, Khamesipour A, Ghoorchi MH, Nassiri-Kashani M, Eskandari SE, Khatami A et al (2006) Imiquimod in combination with meglumine antimoniate for cutaneous leishmaniasis: a randomized assessor-blind controlled trial. Arch Dermatol 142:1575–1579
Garcia Bustos MF, Barrio AB, Parodi Ramoneda CM, Ramos F, Mora MC, Convit J et al (2011) Immunological correlates of cure in the first American cutaneous leishmaniasis patient treated by immunotherapy in Argentina. A case report. Invest Clin 52:365–375
Gonzalez U, Pinart M, Reveiz L, Alvar J (2008) Interventions for Old World cutaneous leishmaniasis. Cochrane Database Syst Rev (4):CD005067
Gonzalez U, Pinart M, Rengifo-Pardo M, Macaya A, Alvar J, Tweed JA (2009) Interventions for American cutaneous and mucocutaneous leishmaniasis. Cochrane Database Syst Rev:CD004834
Goto H, Lauletta Lindoso JA (2012) Cutaneous and mucocutaneous leishmaniasis. Infect Dis Clin North Am 26:293–307
Hartley MA, Kohl K, Ronet C, Fasel N (2013) The therapeutic potential of immune cross-talk in leishmaniasis. Clin Microbiol Infect 19:119–130
Hellier I, Dereure O, Tournillac I, Pratlong F, Guillot B, Dedet JP et al (2000) Treatment of Old World cutaneous leishmaniasis by pentamidine isethionate. An open study of 11 patients. Dermatology 200:120–123
Hervas JA, Martin-Santiago A, Hervas D, Rojo E, Mena A, Rocamora V et al (2012) Old world Leishmania infantum cutaneous leishmaniasis unresponsive to liposomal amphotericin B treated with topical imiquimod. Pediatr Infect Dis J 31:97–100
Jha TK, Sundar S, Thakur CP, Bachmann P, Karbwang J, Fischer C et al (1999) Miltefosine, an oral agent, for the treatment of Indian visceral leishmaniasis. N Engl J Med 341:1795–1800
Krauth-Siegel RL, Inhoff O (2003) Parasite-specific trypanothione reductase as a drug target molecule. Parasitol Res 90(suppl 2):S77–S85
Krylov DM, Koonin EV (2001) A novel family of predicted retroviral-like aspartyl proteases with a possible key role in eukaryotic cell cycle control. Curr Biol 11:R584–R587
Kulkarni MM, Reddy N, Gude T, McGwire BS (2013) Voriconazole suppresses the growth of Leishmania species in vitro. Parasitol Res 112:2095–2099
Lessa HA, Machado P, Lima F, Cruz AA, Bacellar O, Guerreiro J et al (2001) Successful treatment of refractory mucosal leishmaniasis with pentoxifylline plus antimony. Am J Trop Med Hyg 65:87–89
Liese J, Schleicher U, Bogdan C (2008) The innate immune response against Leishmania parasites. Immunobiology 213:377–387
Mahmoudzadeh-Niknam H, McKerrow JH (2004) Leishmania tropica: cysteine proteases are essential for growth and pathogenicity. Exp Parasitol 106:158–163
Mannion-Henderson J, Flaspohler JA, Lemley KR, Rickoll WL, Parsons M (2000) Isolation and characterization of Leishmania mutants defective in glycosomal protein import. Mol Biochem Parasitol 106:225–237
Marovich MA, Lira R, Shepard M, Fuchs GH, Kruetzer R, Nutman TB et al (2001) Leishmaniasis recidivans recurrence after 43 years: a clinical and immunologic report after successful treatment. Clin Infect Dis 33:1076–1079
Marrapu VK, Srinivas N, Mittal M, Shakya N, Gupta S, Bhandari K (2011) Design and synthesis of novel tetrahydronaphthyl azoles and related cyclohexyl azoles as antileishmanial agents. Bioorg Med Chem Lett 21:1407–1410
Miranda-Verastegui C, Llanos-Cuentas A, Arevalo I, Ward BJ, Matlashewski G (2005) Randomized, double-blind clinical trial of topical imiquimod 5% with parenteral meglumine antimoniate in the treatment of cutaneous leishmaniasis in Peru. Clin Infect Dis 40:1395–1403
Motta MC (2008) Kinetoplast as a potential chemotherapeutic target of trypanosomatids. Curr Pharm Des 14:847–854
Negera E, Gadisa E, Hussein J, Engers H, Kuru T, Gedamu L et al (2012) Treatment response of cutaneous leishmaniasis due to Leishmania aethiopica to cryotherapy and generic sodium stibogluconate from patients in Silti, Ethiopia. Trans R Soc Trop Med Hyg 106:496–503
Okwor I, Uzonna JE (2013) The immunology of Leishmania/HIV co-infection. Immunol Res 56:163–171
Oliveira-Neto MP, Mattos M, Souza CS, Fernandes O, Pirmez C (1998) Leishmaniasis recidiva cutis in New World cutaneous leishmaniasis. Int J Dermatol 37:846–849
Olliaro PL (2010) Drug combinations for visceral leishmaniasis. Curr Opin Infect Dis 23:595–602
Paniz Mondolfi AE, Stavropoulos C, Gelanew T, Loucas E, Perez Alvarez AM, Benaim G et al (2011) Successful treatment of Old World cutaneous leishmaniasis caused by Leishmania infantum with posaconazole. Antimicrob Agents Chemother 55:1774–1776
Plewes KA, Barr SD, Gedamu L (2003) Iron superoxide dismutases targeted to the glycosomes of Leishmania chagasi are important for survival. Infect Immun 71:5910–5920
Prasad N, Ghiya BC, Bumb RA, Kaushal H, Saboskar AA, Lezama-Davila CM et al (2011) Heat, oriental sore, and HIV. Lancet 377:610
Reithinger R, Mohsen M, Wahid M, Bismullah M, Quinnell RJ, Davies CR et al (2005) Efficacy of thermotherapy to treat cutaneous leishmaniasis caused by Leishmania tropica in Kabul, Afghanistan: a randomized, controlled trial. Clin Infect Dis 40:1148–1155
Santos LO, Garcia-Gomes AS, Catanho M, Sodre CL, Santos AL, Branquinha MH et al (2013) Aspartic peptidases of human pathogenic trypanosomatids: perspectives and trends for chemotherapy. Curr Med Chem 20:3116–3133
Shakya N, Sane SA, Gupta S (2011) Antileishmanial efficacy of fluconazole and miltefosine in combination with an immunomodulator—picroliv. Parasitol Res 108:793–800
Silva-Jardim I, Horta MF, Ramalho-Pinto FJ (2004) The Leishmania chagasi proteasome: role in promastigotes growth and amastigotes survival within murine macrophages. Acta Trop 91:121–130
Silva-Lopez RE, Morgado-Diaz JA, Chavez MA, Giovanni-De-Simone S (2007) Effects of serine protease inhibitors on viability and morphology of Leishmania (Leishmania) amazonensis promastigotes. Parasitol Res 101:1627–1635
Soto J, Arana BA, Toledo J, Rizzo N, Vega JC, Diaz A et al (2004) Miltefosine for new world cutaneous leishmaniasis. Clin Infect Dis 38:1266–1272
Soto J, Toledo J, Valda L, Balderrama M, Rea I, Parra R et al (2007) Treatment of Bolivian mucosal leishmaniasis with miltefosine. Clin Infect Dis 44:350–356
Soto J, Rea J, Balderrama M, Toledo J, Soto P, Valda L et al (2008) Efficacy of miltefosine for Bolivian cutaneous leishmaniasis. Am J Trop Med Hyg 78:210–211
Soto J, Rea J, Valderrama M, Toledo J, Valda L, Ardiles J et al (2009) Efficacy of extended (six weeks) treatment with miltefosine for mucosal leishmaniasis in Bolivia. Am J Trop Med Hyg 81:387–389
Sundar S, Jha TK, Thakur CP, Bhattacharya SK, Rai M (2006) Oral miltefosine for the treatment of Indian visceral leishmaniasis. Trans R Soc Trop Med Hyg 100(suppl 1):S26–S33
Sundar S, Sinha PK, Rai M, Verma DK, Nawin K, Alam S et al (2011) Comparison of short-course multidrug treatment with standard therapy for visceral leishmaniasis in India: an open-label, non-inferiority, randomised controlled trial. Lancet 377:477–486
Sundar S, Sinha P, Jha TK, Chakravarty J, Rai M, Kumar N et al (2013) Oral miltefosine for Indian post-kala-azar dermal leishmaniasis: a randomised trial. Trop Med Int Health 18:96–100
ter Horst R, Collin SM, Ritmeijer K, Bogale A, Davidson RN (2008) Concordant HIV infection and visceral leishmaniasis in Ethiopia: the influence of antiretroviral treatment and other factors on outcome. Clin Infect Dis 46:1702–1709
Ueno N, Wilson ME (2012) Receptor-mediated phagocytosis of Leishmania: implications for intracellular survival. Trends Parasitol 28:335–344
van Griensven J, Diro E, Lopez-Velez R, Boelaert M, Lynen L, Zijlstra E et al (2013) HIV-1 protease inhibitors for treatment of visceral leishmaniasis in HIV-co-infected individuals. Lancet Infect Dis 13:251–259
Williams RA, Tetley L, Mottram JC, Coombs GH (2006) Cysteine peptidases CPA and CPB are vital for autophagy and differentiation in Leishmania mexicana. Mol Microbiol 61:655–674
Zijlstra EE, Musa AM, Khalil EA, el-Hassan IM, el-Hassan AM (2003) Post-kala-azar dermal leishmaniasis. Lancet Infect Dis 3:87–98
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McGwire, B.S. (2014). Treatment Modalities for Cutaneous and Visceral Leishmaniasis. In: Satoskar, A., Durvasula, R. (eds) Pathogenesis of Leishmaniasis. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9108-8_6
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DOI: https://doi.org/10.1007/978-1-4614-9108-8_6
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