Treatment of Cutaneous Leishmaniasis in Travelers 2009

Abstract

Leishmaniasis is an infection caused by intracellular protozoan parasites of the genus Leishmania and it is transmitted by various species of sand flies. Apart from disseminated visceral leishmaniasis (kala azar), nodules, patches/plaques, ulcerative skin lesions, and destructive mucosal inflammation comprise the wide range of clinical manifestations. With regard to cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML), the parasite species are divided into Old World (Southern Europe, the Middle East, Asia, and Africa) and New World leishmaniasis (Latin America). While most of the Old World species cause benign cutaneous disease, a variety ranging from mild cutaneous disease to severe mucosal lesions is seen among the American species. CL is one of the 10 leading presentation diseases among tourists from tropical countries with skin diseases and was found in 3% of travelers with skin disorders. 1 Because of the broad clinical spectrum of CL and resemblance with common skin diseases such as bacterial or fungal infections and tumors, the correct diagnosis is initially often missed. However, a delayed diagnosis may lead to mucosal spread. Furthermore, treatment of the various species may be different and a suboptimal treatment may cause a prolonged course of the disease and may be associated with disfiguring scars. 2,3 The broad availability of polymerase chain reaction (PCR) allows a rapid determination of species. A species‐specific treatment approach has been evaluated for many species and is widely applied in many centers. 4–9 These treatment options need to be regularly adapted integrating new knowledge and data. This manuscript focuses on new aspects of established compounds and on new drugs such as miltefosine and the combination of traditional compounds with immunomodulators. Recent data focusing on genetic differences of individual species between regions are integrated and region‐specific treatment recommendations for Leishmania braziliensis 10,11 and Leishmania guyanensis 12 CL are given. In many … Corresponding Author: Johannes Blum, MD, DTM&H, Medical Department Swiss Tropical Institute, Socinstrasse 57, CH 4002 Basel, Switzerland. E‐mail:johannes.blum{at}unibas.ch