Leishmania and Leishmaniasis
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The total dose is dependent on the clinical response and the adverse effects, including nephrotoxicity, hepatotoxicity, hypertension, hypoglycemia, hyperglycemia rarely , electrocardiographic alterations, gluteal abscess, central facial paresthesia, cephalea, epigastralgia, and vertigo.
Treatment failure for VL with pentavalent antimonial SSG has been reported in recent years in Nepal; as a result, liposomal amphotericin B is currently recommended by the National Program of Nepal for kala-azar treatment The drug also results in a good response in immunocompromised patients, but the percentage of recurrences in these patients is high. Amphotericin B is an extremely effective but toxic alternative; it is effective even in forms resistant to antimonials.
Clinical improvement is observed from 7 to 10 days after therapy is initiated; after 2 weeks of treatment, the clinical cure is almost complete with cessation of fever, decrease in size of the spleen, and absence of amastigotes in the aspirate. An alternative is the transfer factor and more recently paromomycin, which has finished phase III experimental studies in India and Africa and has been approved in some cases 49 , In cases caused by L.
Fluconazole has not been demonstrated to be effective as a therapeutic option Clinical studies with paromomycin and miltefosine have shown them to be useful; currently, the combination of thermotherapy and miltefosine has been considered as an effective alternative in the treatment of CL 4 , 67 , However, in a phase II open-label, non-comparative randomized trial conducted in Sudan and Kenya to evaluate the efficacy and safety of three treatment regimens for VL caused by L.
Another alternative in the local treatment of LCL is the injection of intralesional amphotericin, which has demonstrated its effectiveness using 2. Thermotherapy, cryosurgery, curettage, and laser and radiotherapy have been tried with relative efficacy 1 , 4 , 72 , Sometimes, in spite of successful treatment, recurrent lesions have been reported Immunotherapy that combines topical imiquimod with systemic antimonials and vaccines against the sand fly will be fundamental for the future treatment and prevention of leishmaniasis F Faculty Reviews are commissioned from members of the prestigious F Faculty and are edited as a service to readers.
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In order to make these reviews as comprehensive and accessible as possible, the referees provide input before publication and only the final, revised version is published. The referees who approved the final version are listed with their names and affiliations but without their reports on earlier versions any comments will already have been addressed in the published version.
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Published online May Author information Article notes Copyright and License information Disclaimer. Competing interests: The authors declare that they have no competing interests. Accepted May This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Leishmaniasis is caused by an intracellular parasite transmitted to humans by the bite of a sand fly. Keywords: Leishmaniasis, Leishmania, cutaneous-chondral, chicleros ulcer.
Introduction Leishmaniasis is a tropical and subtropical disease caused by an intracellular parasite transmitted to humans by the bite of a sand fly, mainly Phlebotomus and Lutzomyia Europe, Northern Africa, the Middle East, Asia, and part of South America ; exceptionally, transmission has also been reported as a laboratory accident 1. Epidemiology Leishmaniasis is a disease with a worldwide distribution; it is found in about 89 countries 4 , 5. Open in a separate window. Figure 1. Rainforests where chewing gum workers and farmers extract sap from Manilkara zapota trees chewing gum tree.
Etiopathogenesis The putative vectors of the different species and subspecies of protozoa of the Leishmania genus are dipterans of the genus Lutzomyia in the New World and Phlebotomus in the old continent belonging to the subfamily Phlebotominae. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Diffuse cutaneous leishmaniasis This form is characterized by anergy that is, lack of cellular immune response to parasite antigens. Figure 7. Figure 8. Visceral leishmaniasis, or kala-azar black fever The febrile infectious illness known as kala-azar black fever spreads over a large part of south and east Asia mainly in India and China , a large part of Africa, the Mediterranean affecting children and adults , and South America where children are affected.
Diagnosis Diagnosis is based on the clinical and congruent epidemiological context Histopathological data In cases of LCL, sections stained with hematoxylin and eosin show epidermal atrophy or hyperplasia with an inflammatory infiltrate consisting of macrophages, lymphocytes, and plasma cells with focal necrotic areas. Cultures The culture is performed through the inoculation of the triturated tissue in special media.
Laboratory data The Montenegro skin test is sensitive and specific. Prophylaxis The eradication of the vector through insecticides, elimination of stagnant water, use of insect repellents, and prophylaxis can be achieved through the use of thick clothes with long sleeves that can be impregnated with insecticides 4 and long pants and by avoiding night walks in jungle areas Notes [version 1; referees: 2 approved].
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Funding Statement The author s declared that no grants were involved in supporting this work. References 1. Reference Source [ Google Scholar ]. Mem Inst Oswaldo Cruz. Lancet Infect Dis. Infect Disord Drug Targets. Biomed Res Int. Rev Biomed.
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Leishmaniasis: A Review on Parasite, Vector and Reservoir Host | Insight Medical Publishing
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