eMedicine Specialties > Infectious Diseases > Parasitic Infections

Leishmaniasis: Follow-up

Author: Craig G Stark, MD, Regional Medical Director, Northern Europe and Russia Regions, Tricare Medical Director for Western Hemisphere, International SOS Assistance UK, Ltd
Contributor Information and Disclosures

Updated: Mar 27, 2008

Follow-up

Further Inpatient Care

  • Provide supportive care for patients with visceral and severe mucocutaneous leishmaniasis, as required.
    • At the onset of therapy, patients are admitted for laboratory and cardiac monitoring.
    • Use antibiotic therapy to treat superimposed bacterial wound infections.
    • An infectious disease specialist should be consulted for definitive diagnosis and treatment.

Further Outpatient Care

  • Perform a follow-up evaluation for patients 6 weeks after last dose.
  • Improvement in cutaneous disease is expected within the first couple of weeks.
  • Patients with visceral disease should defervesce around 72 hours, with resolution of hepatosplenomegaly by 28 days.
  • Severe leishmaniasis recidivans, mucocutaneous leishmaniasis, diffuse cutaneous leishmaniasis, and post-kala-azar leishmaniasis are often difficult to treat and may require prolonged therapy.
  • Retreatment or second-line drugs may be required in patients with resistant disease.

Transfer

  • Patients should receive treatment at facilities experienced with the use of pentavalent antimony compounds.

Deterrence/Prevention

  • After successful treatment, patients generally acquire immunity from the Leishmania species with which they were infected.
    • In some areas of the world, children are superficially inoculated with infected material in concealed areas to induce infection, to promote immunity, and to prevent facial scarring.
    • Attempts to create a viable human vaccine along similar lines have been met with difficulty and have resulted in persistent cutaneous lesions. In May 2005, French researchers from the IRD Montpellier Research Centre successfully developed a novel vaccine against visceral leishmaniasis in dogs.20 Using antigen proteins excreted by the parasite at the 100- and 200-mcg dose, 100% of the dogs (9 of 9) showed immunity over a period of 2 years after infection with L infantum. Immunity appears to be related to activation of the Th1 lymphocytes, allowing macrophages to produce nitric oxide and to clear the leishmania parasites. Researchers postulate that, by reducing the disease burden in dogs, the transmission cycle can be interrupted, indirectly reducing human infections. This new approach is currently being evaluated for incorporation into human vaccines.
  • Reservoir eradication, vector control, and mass treatment of individuals who are infected have met with some success but are limited by cost and difficulty in coordinating efforts.
  • Insect repellent, protective clothing, and permethrin-impregnated mosquito nets offer some protection for visitors to endemic areas. The female sandfly is small enough to pass through standard mosquito nets, thus requiring specially designed netting.

Prognosis

  • Generally, the prognosis is excellent with appropriate therapy.
  • Mortality in patients with visceral disease is reduced to approximately 5% with early therapy.
    • Without therapy, most patients with visceral disease die within 2 years.
    • In some endemic regions, pentavalent antimonial resistance is causing increased mortality rates.

Patient Education

  • Educate patients about the possibility of recurrent disease and instruct them to schedule follow-ups as needed.
  • Education on risk factors and the transmission of leishmaniasis can help reduce disease. Risk factors include the following:
    • Exposure to sandfly habitat
    • Age (depending on infecting species and geographic area)
    • Male sex
    • Adults who are immunologically naïve and entering endemic area
    • Patients who are immunosuppressed (eg, transplant recipients, chronic steroid use, malignancy)
    • Malnutrition
    • AIDS
    • People who use intravenous drugs in endemic areas

Miscellaneous

Medicolegal Pitfalls

  • Drug-resistant strains of leishmaniasis are appearing because of the unregulated use of pentavalent antimony compounds. Improper dosing and shortened duration of therapy are contributing factors.

Special Concerns

  • The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
 


More on Leishmaniasis

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Differential Diagnoses & Workup: Leishmaniasis
Treatment & Medication: Leishmaniasis
Follow-up: Leishmaniasis
Multimedia: Leishmaniasis
References
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Further Reading

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Keywords

leishmaniasis, cutaneous leishmaniasis, mucosal leishmaniasis, visceral leishmaniasis, dermal leishmaniasis, post-kala-azar dermal leishmaniasis, leishmaniasis recidivans, mucocutaneous leishmaniasis, viscerotropic leishmaniasis, black fever, kala-azar, forest yaws, Aleppo evil, Baghdad sore, Biskra button, Chiclero ulcer, Delhi boil, Oriental sore, Rose of Jericho, Uta, dumdum fever, Assam fever, infantile splenomegaly

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Contributor Information and Disclosures

Author

Craig G Stark, MD, Regional Medical Director, Northern Europe and Russia Regions, Tricare Medical Director for Western Hemisphere, International SOS Assistance UK, Ltd
Craig G Stark, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, International Society of Travel Medicine, Phi Beta Kappa, and Society of US Army Flight Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Pranatharthi Haran Chandrasekar, MD, Director of Infectious Disease Fellowship, Professor, Department of Internal Medicine, Harper Hospital, Wayne State University School of Medicine
Pranatharthi Haran Chandrasekar, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas M Kerkering, MD, Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia
Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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