Abstract
Leishmaniasis is a vector-borne parasitic disease that has been neglected in priority for control and eradication of malaria, tuberculosis, and HIV/AIDS. Collectively, over one seventh of the world’s population is at risk of being infected with 0.7–1.2 million new infections reported annually. Clinical manifestations range from self-healing cutaneous lesions to fatal visceral disease. The first anti-leishmanial drugs were introduced in the 1950′s and, despite several shortcomings, remain the mainstay for treatment. Regardless of this and the steady increase in infections over the years, particularly among populations of low economic status, research on leishmaniasis remains under funded. This review looks at the drugs currently in clinical use and how they interact with the host immune response. Employing chemoimmunotherapeutic approaches may be one viable alternative to improve the efficacy of novel/existing drugs and extend their lifespan in clinical use.
Highlights
Leishmaniasis, one of the World Health Organisation (WHO) top 20 neglected tropical diseases (NTDs), is caused by infection with kinetoplastid protozoans of the genus Leishmania (Table 1)
Topical formulations of PR are the most commonly used since the hallmark of cutaneous leishmaniasis (CL) is skin lesions and it is therapeutic against both Old World leishmaniasis (OW) and New World leishmaniasis (NW) CL [92,93]
Leishmaniasis is a severely neglected disease despite the immense suffering it places on the host, especially in regions of economic instability
Summary
Leishmaniasis, one of the World Health Organisation (WHO) top 20 neglected tropical diseases (NTDs), is caused by infection with kinetoplastid protozoans of the genus Leishmania (Table 1). Amastigotes multiply within infected cells, until cells burst releasing parasites that disseminate to species-specific sites of infection, causing the clinical symptoms associated with CL, MCL, or VL Reservoir hosts such as dogs, are very important in the transmission of VL in endemic areas, and these hosts should be considered in clinical and veterinary Leishmania control programmes [7,8]. The WHO has identified leishmaniasis as a control priority; it is often overlooked in favour of research funding for HIV/AIDS, malaria, and tuberculosis These diseases received 42.1% of the WHO health development research budget whilst NTDs only received 0.6%, which seems inadequate given their severity and associated mortality. We further discuss types of immunotherapies and host-directed therapies that could be combined as immunochemotherapies towards a novel treatment regimen, whilst bearing in mind that any intervention must not select for genetic changes that enhance parasite survival within the host
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