Review of the current treatments for leishmaniases

Abstract

Leishmaniases are vector-borne zoonotic diseases that are prevalent in tropical and subtropical areas in the world, with two million new cases occurring yearly. Visceral and tegumentary forms of leishmaniasis are known. The latter form may present as localized cutaneous or mucosal forms, disseminated, diffuse forms, or leishmaniasis recidiva cutis. Visceral leishmaniasis is caused by parasites of the species Leishmania (Leishmania) donovani and L. (L.) infantum, and tegumentary leishmaniasis is caused by 15 other species, with distinct distributions in the Old and New World. The varied clinical manifestations, the multitude of Leishmania species, and the increasing incidence of HIV coinfection make the diagnosis and treatment of leishmaniases complex. Since there are no solid data relating clinical manifestations, treatment outcomes and Leishmania species the decision regarding the best therapeutic option is almost entirely based on clinical manifestations. Because most of the literature is focused on leishmaniasis in the Old World, in this review we present data on the treatment of New World leishmaniasis in more detail. Ranked therapeutic options, clinical trials, and also observations, even with a restricted number of subjects, on treatment outcome of visceral and different forms of tegumentary leishmaniasis, are presented. Treatment for leishmaniasis in HIVcoinfected patients is addressed as well. Some of these data strongly suggest that the differences in the outcome of the treatment are related to the Leishmania species. Therefore, although it is not possible at most points of care to identify the species causing the infection-a process that requires a well equipped laboratory-the infecting species should be identified whenever possible. More recent approaches, such as the use of immunomodulators and immunotherapy, and the lines for development of new candidate drugs are mentioned.

Performance of rK39-based immunochromatographic rapid diagnostic test for serodiagnosis of visceral leishmaniasis using whole blood, serum and oral fluid

“…Visceral leishmaniasis (VL) is a disease caused by a protozoan of the genus Leishmania, the species Leishmania (Leishmania) donovani prevalent in the Indian subcontinent and East Africa, and L. (L.) infantum in other parts of Asia and Africa, Europe and New World [1][2][3]. L. (L.) infantum infection is transmitted by the bite of sandflies belonging to Phlebotomus spp, and dogs are the main peridomestic reservoir [4].…”

Antileishmanial Chemotherapy through Clemastine Fumarate Mediated Inhibition of the Leishmania Inositol Phosphorylceramide Synthase

“…L. major is classified as an Old World species, prevalent in the Eastern hemisphere, and manifests as CL, the most common form of the disease. 33 However, given the global reach of leishmaniasis, the ideal drug is one that is active against all pathogenic species of Leishmania and therefore has the potential to treat all forms of the disease. To explore this possibility, clemastine fumarate was also tested against promastigote forms of L. amazonensis , which causes New World CL in the Western hemisphere, 34 and L. infantum and L. donovani , which both manifest as VL, the most fatal form of the disease.…”

“…To explore this possibility, clemastine fumarate was also tested against promastigote forms of L. amazonensis , which causes New World CL in the Western hemisphere, 34 and L. infantum and L. donovani , which both manifest as VL, the most fatal form of the disease. 33 …”

Antileishmanial activity and evaluation of the mechanism of action of strychnobiflavone flavonoid isolated from Strychnos pseudoquina against Leishmania infantum

“…In addition, leishmaniasis has emerged as an opportunistic infection in human immunodeficiency virus-infected patients (Alvar et al, 1997;Cota et al, 2014;Singh, 2015). Therefore, the development of new strategies to treat leishmaniasis has become a priority (Goto, 2012).…”