• Medical Author:
    Mary D. Nettleman, MD, MS, MACP

    Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

What is the treatment for leishmaniasis?

Visceral leishmaniasis is treated with an intravenous medication called liposomal amphotericin B, which is the only drug approved in the U.S. for this purpose. Amphotericin is generally safe but may have side effects, including renal insufficiency. In developing countries where the drug is not available, an older agent called pentavalent antimony (SbV) may be used intravenously or intramuscularly. More recently, paromomycin (Humatin) and miltefosine (Miltex) have been used, but neither is available in the United States.

Cutaneous leishmaniasis is not always treated. Cases with few lesions that are small and appear to be healing are sometimes simply monitored. More significant disease is treated with medications, but treatment recommendations vary with where the disease was acquired and the species of Leishmania (if known). Possible treatments for cases arriving in the U.S. include oral ketoconazole (Nizoral, Extina, Xolegel, Kuric), intravenous pentamidine, or liposomal amphotericin B. An antimonite called stibogluconate (Pentostam) is available under an investigational new drug protocol through the CDC. Because treatment must be individualized according to the country of acquisition and the species, consultation with public-health officials, infectious-disease consultants, and the CDC is strongly recommended. Mucocutaneous leishmaniasis is less common, and there is no clear consensus on treatment; as such, consultation with the CDC and an infectious-diseases consultant is again recommended.

What is the prognosis of leishmaniasis?

Cutaneous leishmaniasis is rarely fatal but may result in disfiguring scars. Untreated, severe cases of visceral leishmaniasis are almost always fatal. Death can result directly from the disease through organ failure or wasting syndromes. It may also occur as a result of a secondary bacterial infection such as pneumonia. In people with advanced HIV/AIDS, it is necessary to treat the underlying HIV infection along with the leishmaniasis to avoid relapse of the leishmaniasis. For this reason, patients with leishmaniasis should be tested for HIV.

Medically Reviewed by a Doctor on 11/18/2015

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