JAC Advance Access published online on January 16, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh058
© 2004 by The British Society for Antimicrobial Chemotherapy
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Review
1 Swiss Tropical Institute,
Socinstrasse 57, 4002 Basel;
* Corresponding author. E-mail: johannes.blum{at}unibas.ch.
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
Treatment of cutaneous leishmaniasis among travellers
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; Sackler
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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