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Leishmaniasis — Clinical Guidelines

Overview

Leishmaniasis is a vector-borne parasitic disease caused by protozoans of the genus Leishmania, transmitted via phlebotomine sand flies. It manifests in various forms including cutaneous, mucocutaneous, and visceral, posing significant public health challenges, especially in endemic regions 1 14.

Diagnosis

Clinical Presentation: Nasal congestion, nosebleeds, skin lesions, and mucosal ulcers may indicate mucocutaneous leishmaniasis 15.

Laboratory Tests: Serological tests (e.g., ELISA, DAT, IFA) and parasitological confirmation (microscopy, culture) are crucial 4 16.

Special Considerations: Otorhinolaryngologic examination is vital for diagnosing ENT region lesions 4 13.

Management

First-Line Treatments:

- Visceral Leishmaniasis: Amphotericin B (intravenous), Miltefosine (oral) 1 11. - Cutaneous Leishmaniasis: Glucocorticoids for ulcer management, Paromomycin (topical/intramuscular) 1 11.

Adjunctive Treatments:

- Nutritional support, especially in malnourished patients, to enhance immune response 7. - Monitoring for complications, particularly in patients on TNF-α inhibitors 4.

Special Populations

Immunocompromised Patients: Increased vigilance for atypical presentations like tonsillitis 16.

Pregnancy: Limited data; treatment should be individualized based on severity and potential risks 5.

Children: Special attention to accurate diagnosis and management due to higher vulnerability 9.

Key Recommendations

Early Diagnosis is Critical: Utilize serological tests and parasitological confirmation for accurate diagnosis of leishmaniasis 15 (Evidence: Strong).

Tailored Treatment Based on Form: Use Amphotericin B for visceral leishmaniasis and consider Paromomycin for cutaneous forms 1 11 (Evidence: Strong).

Nutritional Support for Malnourished Patients: Enhance immune response and therapeutic outcomes in malnourished individuals 7 (Evidence: Moderate).

Monitor for Complications in TNF-α Inhibitor Users: Increased risk of leishmaniasis in these patients necessitates close monitoring 4 (Evidence: Moderate).

References

1 Abdulqader A, Abdulsada FM, Al-Dulemey MQ, Shamsir MS. "Proteome-wide immunoinformatics analysis of Leishmania major: discovery of eight novel vaccine candidates and systematic evaluation of historical targets". Acta tropica 2026. link 2 Ovais M, Kanwal M, Naz S, Aziz T, Al-Hoshani N, Alwethaynani MS et al.. Revolutionizing leishmaniasis control: leveraging immunoinformatics for precision-driven . Allergologia et immunopathologia 2026. link 3 Ali MT, Rahman T, Palit P, Uddin MI, Seidel V. Targeting the zinc metalloprotease gp63 of Leishmania for vaccine design and new drug discovery using immunoinformatics, molecular docking and molecular dynamics simulation studies. Experimental parasitology 2025. link 4 Penella A, Muntaner-Virgili C, Marcoval J, González-Compta X, Mesalles-Ruiz M, García Wagner M et al.. Leishmaniasis in otorhinolaryngology: an emerging disease and its relationship with anti-tumor necrosis factor-alpha drugs. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2024. link 5 Bahrami F, Mostafavi E. In Commemoration of Dr. Farrokh Modabber: An Iranian Pioneer of Cellular Immunology, and Leishmaniases Vaccine Research in Iran and the World. Archives of Iranian medicine 2024. link 6 Kashif M, Waseem M, Subbarao N. In silico prediction of CD8. Journal of molecular graphics & modelling 2024. link 7 Kumar VU, Kt MF, Sharma A, Bisht P, Dhingra S, Ravichandiran V et al.. The Possible Role of Selected Vitamins and Minerals in the Therapeutic Outcomes of Leishmaniasis. Biological trace element research 2023. link 8 Perilla-Gonzalez Y, Gomez-Suta D, Delgado-Osorio N, Hurtado-Hurtado N, Baquero-Rodriguez JD, Lopez-Isaza AF et al.. Study of the scientific production on leishmaniasis in Latin America. Recent patents on anti-infective drug discovery 2014. link 9 Mansueto P, Seidita A, Vitale G, Cascio A. Transfusion transmitted leishmaniasis. What to do with blood donors from endemic areas?. Travel medicine and infectious disease 2014. link 10 Carmelo E, González G, Cruz T, Osuna A, Hernández M, Valladares B. Characterization of monomeric DNA-binding protein Histone H1 in Leishmania braziliensis. Parasitology 2011. link 11 Fessel MR, Lira CB, Giorgio S, Ramos CH, Cano MI. Sir2-Related Protein 1 from Leishmania amazonensis is a glycosylated NAD+-dependent deacetylase. Parasitology 2011. link 12 Matos DC, Faccioli LA, Cysne-Finkelstein L, Luca PM, Corte-Real S, Armôa GR et al.. Kinetoplastid membrane protein-11 is present in promastigotes and amastigotes of Leishmania amazonensis and its surface expression increases during metacyclogenesis. Memorias do Instituto Oswaldo Cruz 2010. link 13 Boaventura VS, de Oliveira JG, Costa JM, Novais FO, de Oliveira CI, Barral-Netto M et al.. The value of the otorhinolaryngologic exam in correct mucocutaneous leishmaniasis diagnosis. The American journal of tropical medicine and hygiene 2009. link 14 . Etymologia - Leishmaniasis. Emerging infectious diseases 2008. link 15 Roscoe M. Leishmaniasis: early diagnosis is key. JAAPA : official journal of the American Academy of Physician Assistants 2005. link 16 Kouyialis S, Archontakis S, Bilinis C, Nikolaou S, Stavropoulou E, Samaras C et al.. Report of an atypical case of leishmaniasis presented as acute tonsillitis in an immunocompetent patient. Scandinavian journal of infectious diseases 2005. link 17 Vinayak VK, Singla N, Dutt P, Mahajan D. Isolation of the 66-kilodalton polypeptide from promastigotes of Leishmania donovani as a ligand molecule for binding to macrophages. Japanese journal of medical science & biology 1991. link 18 Rivas L, Kahl L, Manson K, McMahon-Pratt D. Biochemical characterization of the protective membrane glycoprotein GP46/M-2 of Leishmania amazonensis. Molecular and biochemical parasitology 1991. link90183-7) 19 Ray R, Ghose AC. Somatic and excretory polysaccharide antigens of Leishmania donovani promastigotes. The Australian journal of experimental biology and medical science 1985. link 20 Gardiner PR, Dwyer DM. Radioiodination and identification of externally disposed membrane components of Leishmania tropica. Molecular and biochemical parasitology 1983. link90075-0) 21 Belehu A, Naafs B, Touw-Langendijk E. Failure of metronidazole treatment in Ethiopian mucocutaneous leishmaniasis. The British journal of dermatology 1978. link

Leishmaniasis