Mucosal leishmaniasis . Current scenario and prospects for treatment.
Leishmaniasis causes significant morbidity and mortality and thus constitutes a serious public health problem. Even though it has long been endemic in developing countries, in recent years the economic globalization and the increased volume of international travel have extended its prevalence in developed countries. In addition, native populations may be exposed to the infection through blood transfusion and the use of blood products produced from infected asymptomatic individuals. Mucosal leishmaniasis (ML) is a chronic form of this infection, which attacks the mucosa. In most cases this form of leishmaniasis results from the metastatic spread of Leishmania (Viannia) braziliensis from cutaneous lesions. It is a healthcare issue because of its wide demographic distribution, its association with significant morbidity levels, and because of the pressing concern that tourists who travel to endemic areas might present the disease even years later. The treatment currently available for ML is based on drugs such as pentavalent antimony-containing compounds, amphotericin B deoxycholate and pentamidine and often guarantees a satisfactory clinical response. Nevertheless, it also frequently provokes serious side effects. This review offers a critical analysis of the drugs now available for the treatment of ML as also of the future prospects for the treatment of the disease.
Amato
Valdir Sabbaga
VS
Infectious and Parasitic Diseases Clinic, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, 05403-010, São Paulo, Brazil. valdirsa@netpoint.com.br
Tuon
Felipe Francisco
FF
Bacha
Hélio Arthur
HA
Neto
Vicente Amato
VA
Nicodemo
Antonio Carlos
AC
D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000965:Antimony / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D003840:Deoxycholic Acid / Q000627:therapeutic use; D019049:Developed Countries; D003906:Developing Countries; D004338:Drug Combinations; D019353:Endemic Diseases; D006801:Humans; D007892:Leishmania braziliensis / Q000302:isolation & purification*; D007897:Leishmaniasis, Mucocutaneous / Q000188:drug therapy* / Q000453:epidemiology* / Q000469:parasitology; D010419:Pentamidine / Q000627:therapeutic use; D014195:Travel
D000981:Antiprotozoal Agents; D004338:Drug Combinations; D003840:Deoxycholic Acid; D010419:Pentamidine; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D000965:Antimony