Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis

Abstract

Tegumentary leishmaniasis, comprising the cutaneous and mucocutaneous forms, is caused by at least 13 dermotropic species of protozoa of the genus Leishmania, most of which are prevalent in the New World. Although diseases in the Old and New Worlds share similar characteristics, the ultimate manifestations and severity are quite different, with more severe forms associated with mucosal lesions observed in the New World. For the diagnosis and treatment of leishmaniasis, differences based on clinical features, usefulness/sensitivity of diagnostic methods and therapeutic responses are mainly emphasized. We present a critical review of the diagnostic methods, their contribution and the necessity for their improvement/development, particularly in molecular diagnosis aimed at detection and species identification, as well as serodiagnosis. In addition to a review of the drugs currently utilized, we describe differences in their effectiveness in Old and New World leishmaniasis. HIV/Leishmania coinfection is also presented in the context of diagnosis and treatment.

Keywords::

• amphotericin B
• coinfection
• ELISA
• HIV
• human
• Leishmania
• PCR
• pentamidine
• pentavalent antimonials
• serodiagnosis

Acknowledgements

The authors thank Fernando T Silveira, Jackson ML Costa and Luiza K Oyafuso for kindly providing and authorizing the publication of patients’ lesion pictures.

Financial & competing interests disclosure

This work was supported by Fundação de Amparo a Pesquisa do Estado de São Paulo, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Conselho Nacional de Pesquisa, Financiadora de Estudos e Projetos and Laboratório de Investigação Médica 38, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.