02342nas a2200217 4500000000100000008004100001260001200042653001900054653002800073653003200101653001400133653002700147100001400174700001700188245008000205856006600285300000900351490000700360520174300367022001402110 2024 d c02/202410aAdverse events10aCutaneous leishmaniasis10aMucocutaneous leishmaniasis10aTreatment10aVisceral Leishmaniasis1 aShmueli M1 aBen-Shimol S00aReview of Leishmaniasis Treatment: Can We See the Forest through the Trees? uhttps://www.mdpi.com/2226-4787/12/1/30/pdf?version=1707382590 a1-130 v123 a
There are three known clinical syndromes of leishmaniasis: cutaneous (CL), mucocutaneous (MCL), and visceral disease (VL). In MCL and VL, treatment must be systemic (either oral or intravenous), while CL treatment options vary and include observation-only localized/topical treatment, oral medications, or parenteral drugs. Leishmaniasis treatment is difficult, with several factors to be considered. First, the efficacy of treatments varies among different species of parasites prevalent in different areas on the globe, with each species having a unique clinical presentation and resistance profile. Furthermore, leishmaniasis is a neglected tropical disease (NTD), resulting in a lack of evidence-based knowledge regarding treatment. Therefore, physicians often rely on case reports or case series studies, in the absence of randomized controlled trials (RCT), to assess treatment efficacy. Second, defining cure, especially in CL and MCL, may be difficult, as death of the parasite can be achieved in most cases, while the aesthetic result (e.g., scars) is hard to predict. This is a result of the biological nature of the disease, often diagnosed late in the course of disease (with possible keloid formation, etc.). Third, physicians must consider treatment ease of use and the safety profile of possible treatments. Thus, topical or oral treatments (for CL) are desirable and promote adherence. Fourth, the cost of the treatment is an important consideration. In this review, we aim to describe the diverse treatment options for different clinical manifestations of leishmaniasis. For each currently available treatment, we will discuss the various considerations mentioned above (efficacy, ease of use, safety, and cost).
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