Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany

Leishmaniasis in rheumatology, haematology and oncology: epidemiological, immunological and clinical aspects and caveats: Figure 1

“…However, it is advisable to combine PCR with microscopy (Giemsa staining of the parasite (nucleus and kinetoplast)) and parasite culture (performed in serial dilutions in microtitre plates with media optimised for Leishmania growth), which are inexpensive techniques that will increase specificity, yield semiquantitative data on the parasite load and allow for drug resistance and molecular analyses (species identification) 3 118 119 121. To this end, non-fixed tissue specimens placed in sterile physiological NaCl solution (biopsy of skin, liver or spleen) or treated with EDTA (bone marrow biopsy, peripheral blood) need to be obtained 122. Importantly, a single bone marrow smear alone is insufficient to exclude VL because the density of intracellular amastigotes can be very low, even in clinically acute VL.…”

“…For a detailed description of all protocols and approaches for the treatment of CL, MCL and VL, the reader is referred to previous detailed reviews18 148–154 and guidelines 122. In many cases CL in the Old World (Africa, Asia and Europe) is self-healing which, however, can take months and is associated with scar formation.…”

“…Possible therapeutic strategies are (a) intralesional, intramuscular or intravenous application of pentavalent antimony compounds (notably sodium stibogluconate or N-methyl-glucamine antimoniate (meglumine)); (b) intravenous or intramuscular injection of pentamidine; (c) intravenous application of liposomal amphotericin B; (d) oral treatment with azoles (fluconazol, ketoconazol); (e) oral treatment with miltefosine (hexadecylphosphocholine); (f) local application of paromomycin (aminosidine) ointments containing methylbenzethonium chloride; (g) different forms of thermotherapy; (h) cryotherapy; and (i) moist wound treatment with pharmaceutical sodium chlorite after removal of necrotic tissue by electrothermocauterisation (KW Stahl and C Bogdan, unpublished data). Unfortunately, the cure rates very much depend on the parasite species, most treatment regimens have not been evaluated by placebo-controlled randomised double-blind trials and the use of several leishmanicidal drugs (eg, antimony, pentamidine) is hampered by considerable toxicity 18 122 150 151. Unlike Old World CL, infections with Leishmania species of the New World (Central and South America) subgenus Viannia ( L V braziliensis , L V peruviana , L V guyanensis , L V panamensis ) need to be treated systemically with antileishmanial agents (antimony, miltefosin or amphotericin B) in order to prevent subsequent MCL 122 149 152 153 155…”

“…Unfortunately, the cure rates very much depend on the parasite species, most treatment regimens have not been evaluated by placebo-controlled randomised double-blind trials and the use of several leishmanicidal drugs (eg, antimony, pentamidine) is hampered by considerable toxicity 18 122 150 151. Unlike Old World CL, infections with Leishmania species of the New World (Central and South America) subgenus Viannia ( L V braziliensis , L V peruviana , L V guyanensis , L V panamensis ) need to be treated systemically with antileishmanial agents (antimony, miltefosin or amphotericin B) in order to prevent subsequent MCL 122 149 152 153 155…”

Urlaubs- und Tropendermatosen

“…Jeder Insektenstich, der nicht heilt, oder jedes in den Tropen erworbene Hautgeschwür, das sich nicht schließt, ist verdächtig für eine kutane Leishmaniasis. Eine Über-sicht zu Diagnostik und möglichen Therapieoptionen der kutanen und mukokutanen Leishmaniasis findet sich in einer 2010 aktualisierten Leitlinie, die im Auftrag der deutschen Gesellschaft für Tropenmedizin und internationale Gesundheit und der deutschen Dermatologischen Gesellschaft erstellt wurde [2]. …”