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Abstract
Cutaneous leishmaniasis (CL) is a curable disease; however, due to various risk factors, unresponsiveness to CL treatments is inevitable. The treatment of CL has been firmly correlated with multiple determinants, such as demographical, clinical, and environmental factors, the host’s immune response, poor treatment adherence, the parasite’s genetic make-up, and Leishmania RNA virus. This study primarily focuses on the risk factors associated with different therapeutic outcomes following meglumine antimoniate (MA; Glucantime®) treatment and policy approaches to prevent unresponsiveness in CL patients with a focus on anthroponotic form (ACL). Findings suggest that effective preventive and therapeutic measures should be more vigorously implemented, particularly in endemic areas. Accordingly, extensive training is essential to monitor drug unresponsiveness regularly, especially in tropical regions where the disease is prevalent. Since humans are the fundamental reservoir host of ACL due to L. tropica, prompt detection, early diagnosis, and timely and effective treatment could help control this disease. Furthermore, major challenges and gaps remain: efficacious vaccine, new tools, and expert staff are crucial before CL can be definitively controlled.
Highlights
Leishmaniasis is a multiplex disease induced by protozoa parasites belonging to over 20 different Leishmania species
In urban locations at higher elevations, Cutaneous leishmaniasis (CL) occurs due to L. tropica, existing within an anthroponotic cycle, which is primarily transmitted via the bite of the infected female phlebotomine sand fly, Phlebotomus sergenti (Yaghoobi-Ershadi, 2016)
The present review focused on the risk factors associated with different treatment outcomes following meglumine antimoniate (MA) and formulates policy suggestions for the prevention of unresponsiveness in patients with anthroponotic CL (ACL)
Summary
Leishmaniasis is a multiplex disease induced by protozoa parasites belonging to over 20 different Leishmania species. The treatment of CL is associated with several factors like environmental changes, the patient’s clinical status, the host’s immune response, and the parasite species (WHO, 2017; Bamorovat et al, 2018a). The present review focused on the risk factors associated with different treatment outcomes following MA and formulates policy suggestions for the prevention of unresponsiveness in patients with ACL. Several risk factors may involve ACL unresponsiveness, including demographical factors, clinical factors, poor treatment adherence, environmental factors, the host immune responses, parasite genetic make-up, and Leishmania RNA virus. In a multivariate regression analysis model, Aflatoonian et al (2019) showed that indicators of poor treatment adherence (such as lesion duration of greater than 4 months) were major risk factors significantly associated with unresponsiveness to MA treatment among ACL patients (Aflatoonian et al, 2019). Ginouvès et al (2020) study, the presence or genotypes of LRV-1 in American tegumentary leishmaniasis (ATL) patients with L. guyanensis did not correlate with pentamidine treatment failure
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