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Avances en el tratamiento de la 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
Resumen
Este resumen es generado por máquina.

La leishmaniasis presenta diversas formas clínicas, desde lesiones cutáneas hasta enfermedades viscerales, que a menudo persisten durante toda la vida a pesar del tratamiento. Los desafíos en el control incluyen el manejo limitado de vectores, la ausencia de vacunas y la resistencia a los medicamentos, lo que dificulta la prevención y el tratamiento efectivos.

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Área de la Ciencia:

  • Parasitología Médica.
  • Inmunología Inmunología.
  • Enfermedades infecciosas Enfermedades infecciosas.

Sus antecedentes:

  • La leishmaniasis, una enfermedad parasitaria, presenta un amplio espectro clínico influenciado por las interacciones huésped-parásito y las respuestas inmunes.
  • La infección puede variar desde asintomática hasta localizada en formas cutáneas, mucosas o viscerales, con resultados que varían según la región y la inmunidad del huésped.
  • A pesar de las respuestas inmunológicas y el tratamiento, los parásitos intracelulares pueden persistir durante toda la vida dentro de los macrófagos, lo que lleva a infecciones crónicas o recurrentes.

Objetivo del estudio:

  • Proporcionar una visión global del espectro clínico, el diagnóstico y el tratamiento de la leishmaniasis.
  • Destacar los desafíos y obstáculos en la prevención y el manejo de la leishmaniasis, particularmente en regiones endémicas.
  • Discutir las estrategias de tratamiento emergentes en respuesta a la resistencia a los medicamentos.

Principales métodos:

  • Revisión de las presentaciones clínicas y patrones epidemiológicos de la leishmaniasis.
  • Resumen de los enfoques de diagnóstico, incluyendo microscopía, serología, cultivo y detección de ADN.
  • Análisis de las intervenciones terapéuticas convencionales y nuevas para la leishmaniasis.

Principales resultados:

  • La leishmaniasis se manifiesta en formas subclínicas, localizadas y diseminadas, con variaciones regionales significativas en la presentación y la endemicidad.
  • El diagnóstico se basa en la visualización de parásitos, la serología, el cultivo y la detección de ADN, con métodos de laboratorio que ofrecen una mayor sensibilidad.
  • El antimonio pentavalente sigue siendo un tratamiento primario, pero la resistencia a los medicamentos ha requerido terapias alternativas como la anfotericina B, la paromomicina y la miltefosina.

Conclusiones:

  • El control de la leishmaniasis se ve obstaculizado por factores como la pobreza, el control inadecuado del vector de la mosca de arena, la falta de una vacuna y el desarrollo insuficiente de medicamentos asequibles.
  • A pesar de los avances en el diagnóstico y el tratamiento, la leishmaniasis sigue siendo una enfermedad tropical descuidada que requiere estrategias de control integradas.
  • Abordar la resistencia a los medicamentos y mejorar el acceso a tratamientos efectivos es fundamental para el manejo de la leishmaniasis a nivel mundial.