Visceral Leishmaniasis: Advances in Treatment

Abstract

Visceral leishmaniasis continues to be an important public health problem worldwide. This vector-borne infection affects approximately 500,000 people annually with more than 50,000 associated deaths, a number that among parasite diseases is surpassed by malaria only. Leishmaniasis was recently selected by the World Health Organization for elimination by 2015. Major obstacles for achieving this goal include lack of an antileishmanial vaccine, wide-spread resistance to pentavalent antimonials in the State of Bihar, India where half of cases globally occur, and drawbacks of alternative antileishmanial drugs, including prolonged administration, serious adverse effects, and high costs in poor endemic areas. During the past decade, significant progress has been made towards the development of new and less toxic antileishmanial agents, including the oral agent miltefosine. Currently, there are several agents with antileishmanial activity under investigation as well as patents that may deserve further testing within combination regimens. In order to preserve the activity of available antileishmanial agents, monitoring of their delivery, response, and resistance should be implemented globally. Combination regimens should be further investigated in large trials. The costs of antileishmanial agents should be minimized in poor endemic areas where there are needed most.

Leishmaniasis in travelers: A literature review

“…The pentavalent antimonials meglumine antimoniate and sodium stibogluconate remain the standard antileishmanial treatment for VL in developing endemic areas with the exception of India, where their use has been abandoned due to the occurrence of a widespread antimonial resistance, and they have been replaced with conventional amphotericin B [132,169]. Experience with antimonials for almost 70 years indicates efficacy rates of >90e95% and low fatality and relapse rates [107,135,170,171].…”

Therapeutic switching in leishmania chemotherapy: a distinct approach towards unsatisfied treatment needs

“…This drug should not be administered to women pregnant up to 2 months following drug discontinuation (Wadhone 2009). In India miltefosine is available over the counter, a fact that may expose this drug to misuse and emergence of resistance (Maltezou 2008). Experiences in this region have shown a decrease of efficacy from 97% in the phase III trial to 82% in phase IV trail (Bhattacharya et al 2007).…”

Developments in the treatment of visceral leishmaniasis

“…Next to elimination initiatives, there is a place for programs that intend to limit VL mortality today. In the African VL endemic region, where health systems are poorly Bharat Sera India Phase II, dose finding study finished [54] Oral amphotericin B [80] Sertraline (SSRIs) ?…”

“…Inhibited growth of Leishmania infantum in cultures [80] Azithromycin functional or non-existent, any elimination program will be difficult and slow to implement. Immediate interventions in outbreaks, with active case finding, diagnosis and treatment, are urgent and necessary.…”