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Advances in leishmaniasis.

Henry W Murray1, Jonathan D Berman, Clive R Davies

  • 1Department of Medicine, Weill Medical College of Cornell University, New York, USA. hwmurray@med.cornell.edu

Lancet (London, England)
|November 1, 2005
PubMed
Summary
This summary is machine-generated.

Leishmaniasis presents diverse clinical forms, from skin lesions to visceral disease, often persisting lifelong despite treatment. Challenges in control include limited vector management, no vaccine, and drug resistance, hindering effective prevention and treatment.

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Area of Science:

  • Medical Parasitology
  • Immunology
  • Infectious Diseases

Background:

  • Leishmaniasis, a parasitic disease, presents a broad clinical spectrum influenced by host-parasite interactions and immune responses.
  • Infection can range from asymptomatic to localized cutaneous, mucosal, or visceral forms, with outcomes varying by region and host immunity.
  • Despite immune responses and treatment, intracellular parasites can persist lifelong within macrophages, leading to chronic or relapsing infections.

Purpose of the Study:

  • To provide a comprehensive overview of the clinical spectrum, diagnosis, and treatment of leishmaniasis.
  • To highlight the challenges and obstacles in the prevention and management of leishmaniasis, particularly in endemic regions.
  • To discuss emerging treatment strategies in response to drug resistance.

Main Methods:

  • Review of clinical presentations and epidemiological patterns of leishmaniasis.
  • Summary of diagnostic approaches, including microscopy, serology, culture, and DNA detection.
  • Analysis of conventional and novel therapeutic interventions for leishmaniasis.

Main Results:

  • Leishmaniasis manifests in subclinical, localized, and disseminated forms, with significant regional variations in presentation and endemicity.
  • Diagnosis relies on parasite visualization, serology, culture, and DNA detection, with laboratory methods offering greater sensitivity.
  • Pentavalent antimony remains a primary treatment, but drug resistance has necessitated alternative therapies like amphotericin B, paromomycin, and miltefosine.

Conclusions:

  • Leishmaniasis control is hampered by factors including poverty, inadequate sandfly vector control, lack of a vaccine, and insufficient development of affordable drugs.
  • Despite advances in diagnosis and treatment, leishmaniasis remains a neglected tropical disease requiring integrated control strategies.
  • Addressing drug resistance and improving access to effective treatments are critical for managing leishmaniasis globally.