Treatment Overview
Receiving a diagnosis of leishmaniasis can be a distressing experience, often accompanied by confusion due to the complexity of the disease. For those with the cutaneous form, the appearance of persistent, sometimes painful skin sores can lead to physical discomfort and social anxiety regarding scarring or disfigurement. For those facing the more severe visceral form, symptoms like prolonged fever, weight loss, and weakness can be physically debilitating and frightening. Treatment is crucial not only to heal the visible wounds and prevent permanent scarring but, in systemic cases, to save the patient’s life by stopping the parasite from damaging internal organs.
Because leishmaniasis is caused by over 20 different species of parasites found in varying parts of the world, treatment plans are highly specific. A regimen that works for a traveler who acquired the infection in the Middle East may differ significantly from one prescribed for an infection acquired in South America. The choice of therapy depends on the species of the parasite, the geographic location where the infection occurred, and the patient’s immune system status (Centers for Disease Control and Prevention, 2020).
Overview of treatment options for Leishmaniasis
The primary goal of treating leishmaniasis is to eliminate the parasite from the body to resolve symptoms and prevent relapse. For cutaneous leishmaniasis (skin sores), treatment speeds up healing and reduces the risk of the infection spreading to the nose or mouth (mucocutaneous leishmaniasis). For visceral leishmaniasis (affecting organs), prompt systemic treatment is mandatory to prevent fatal complications.
The approach is categorized into local therapies and systemic therapies. Small, uncomplicated skin lesions may sometimes be treated with heat therapy, cryotherapy (freezing), or topical ointments. However, medication remains the cornerstone of treatment for complex skin cases, mucocutaneous forms, and all visceral infections. These medications are powerful agents designed to kill the parasite and are often administered under the guidance of an infectious disease specialist.
Medications used for Leishmaniasis
Systemic medications are required when the infection is widespread or affects internal organs. Pentavalent antimonials remain a standard first-line treatment in many parts of the world. Drugs such as sodium stibogluconate or meglumine antimoniate are administered via injection. While they have been used for decades, clinical experience suggests that their effectiveness can vary by region due to parasite resistance.
Liposomal amphotericin B has become a preferred treatment in the United States and Europe, particularly for visceral leishmaniasis. This medication is delivered through an intravenous (IV) infusion. It is often chosen for its high efficacy and because the liposomal formulation is less toxic to the kidneys than older versions of the drug.
Miltefosine is the first effective oral treatment for specific cutaneous and visceral leishmaniasis, providing an injection-free alternative. Its convenience is subject to availability and the parasite strain’s susceptibility.
Azole antifungals, such as fluconazole or ketoconazole, are sometimes used off-label for mild cutaneous cases. While typically used for fungal infections, high doses of these drugs can be effective against certain Leishmania species, though they often take longer to show results compared to other treatments.
How these medications work
The medications used to treat leishmaniasis target the biological machinery of the parasite to stop it from replicating.
Pentavalent antimonials kill the parasite by disrupting its energy production (ATP generation) through enzyme inhibition, leading to its inability to survive and subsequent clearance by the immune system.
Amphotericin B targets the parasite’s cell membrane. By binding to sterols, it creates holes that cause cell contents to leak, resulting in rapid parasite death.
Miltefosine disrupts cell membrane integrity and signaling, triggering apoptosis (programmed cell death) and causing the parasite to self-destruct.
Side effects and safety considerations
Leishmaniasis treatments are potent and require monitoring for severe side effects. Pentavalent antimonials can cause joint pain, fatigue, liver enzyme elevation, and heart rhythm issues, necessitating cardiac monitoring.
Amphotericin B (even liposomal) risks kidney strain, requiring regular blood tests for kidney function and electrolytes; infusion reactions (fever/chills) are also possible.
Miltefosine causes GI distress (nausea/vomiting) and is highly teratogenic; pregnancy must be avoided during and after treatment. Seek immediate medical attention for severe abdominal pain, jaundice, or irregular heartbeats with any drug (World Health Organization, 2023).
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- Centers for Disease Control and Prevention. https://www.cdc.gov
- World Health Organization. https://www.who.int
- National Institute of Allergy and Infectious Diseases. https://www.niaid.nih.gov
- MedlinePlus. https://medlineplus.gov
Medications for Leishmaniasis
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Leishmaniasis.