JAC Advance Access originally published online on January 16, 2004
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Journal of Antimicrobial Chemotherapy (2004) 53, 158-166
© 2004 The British Society for Antimicrobial Chemotherapy
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Treatment of cutaneous leishmaniasis among travellers
1 Swiss Tropical Institute, Socinstrasse 57, 4002 Basel; 2 World Health Organization, CPE/EPH, Avenue Appia 20, 1211 Geneva 27, Switzerland; 3 The Center for Geographic Medicine and Department of Medicine C, The Chaim Sheba Medical Center, Tel Hashomer 52621; 4 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Leishmaniasis is endemic in 88 countries on five continents. There are 1–1.5 million cases of cutaneous leishmaniasis reported yearly worldwide. There has been a sharp increase in recorded cases over the last 10 years. Based on geographical distribution, cutaneous leishmaniasis is divided into Old World and New World leishmaniasis. In the past, species could be inferred from geographical setting or determined by performing culture and isoenzyme analysis. The recently developed and now widely available PCR technology allows a rapid diagnosis with determination of most species, and thus enables a species-orientated treatment. While the Old World species mostly cause benign and often self-limiting cutaneous disease, the American species cause a broad spectrum of conditions from benign to severe manifestations, including mucosal involvement. The response to treatment varies according to the species. Therefore, a species-specific approach is proposed. Drugs for systemic and topical treatment are presented and discussed with regard to their application, use and adverse effects. Indications for local or systemic treatment are proposed. Drugs under investigation are also mentioned. An overview of published treatment options and a treatment recommendation is given for each of the most important species. The level of evidence of the studies leading to these recommendations is given.
Keywords: cutaneous leishmaniasis, travel, systemic treatment, local treatment
* Corresponding author. Tel: +41-61-284-82-55; Fax: +41-61-284-81-83; E-mail: johannes.blum{at}unibas.ch
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