Review of the current treatments for leishmaniases

José Angelo Lauletta Lindoso,¹ Jackson Maurício Lopes Costa,² Igor Thiago Queiroz,³ Hiro Goto<sup>4

1</sup>Instituto de Infectologia Emilio Ribas-SES- SP, São Paulo, São Paulo, Brazil; ²Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; ³Departament of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Sao Paulo, Brazil; ⁴Instituto de Medicina Tropical de São Paulo, and Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Sao Paulo, Brazil

Abstract: Leishmaniases are vector-borne zoonotic diseases that are prevalent in tropical and subtropical areas in the world, with two million new cases occurring yearly. Visceral and tegumentary forms of leishmaniasis are known. The latter form may present as localized cutaneous or mucosal forms, disseminated, diffuse forms, or leishmaniasis recidiva cutis. Visceral leishmaniasis is caused by parasites of the species Leishmania (Leishmania) donovani and L. (L.) infantum, and tegumentary leishmaniasis is caused by 15 other species, with distinct distributions in the Old and New World. The varied clinical manifestations, the multitude of Leishmania species, and the increasing incidence of HIV coinfection make the diagnosis and treatment of leishmaniases complex. Since there are no solid data relating clinical manifestations, treatment outcomes and Leishmania species the decision regarding the best therapeutic option is almost entirely based on clinical manifestations. Because most of the literature is focused on leishmaniasis in the Old World, in this review we present data on the treatment of New World leishmaniasis in more detail. Ranked therapeutic options, clinical trials, and also observations, even with a restricted number of subjects, on treatment outcome of visceral and different forms of tegumentary leishmaniasis, are presented. Treatment for leishmaniasis in HIV-coinfected patients is addressed as well. Some of these data strongly suggest that the differences in the outcome of the treatment are related to the Leishmania species. Therefore, although it is not possible at most points of care to identify the species causing the infection – a process that requires a well equipped laboratory – the infecting species should be identified whenever possible. More recent approaches, such as the use of immunomodulators and immunotherapy, and the lines for development of new candidate drugs are mentioned.

Keywords: tegumentary, visceral, therapy, HIV