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VOLUME 25 , ISSUE S2 ( May, 2021 ) > List of Articles



Ishan Rohatgi, Rashmi Mishra

Citation Information :

DOI: 10.5005/jp-journals-10071-23844

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Leishmaniasis is one of the chronic debilitating vector-borne diseases caused by obligate intracellular protozoa. The global burden of disease although not increasing but potential risk of spread is there. At least 20 species of Leishmania are pathogenic to human beings. The transmission is from female sandfly through a blood meal. The disease pathogenesis is dependent on parasite and host mechanism—primarily cell-mediated immunity. The three common forms are visceral, cutaneous, and mucocutaneous. The diagnostic tests are mainly based on aspiration from the spleen or bone marrow. The use of K39 antibodies is the best serodiagnostic test. Antimonial, amphotericin B, miltefosine, and paromomycin are the drugs used to treat leishmaniasis. Amphotericin therapy shows the response within 7 to 10 days in most subjects, and 2 weeks of therapy is sufficient. However, those going into relapse need new treatment regimes. There is a definite benefit of combination therapy. However, there is still no breakthrough on a vaccine for prophylaxis.

  1. Mokni M. Cutaneous leishmaniasis. Ann Dermatol Venereol 2019;146(3):232–246. DOI: 10.1016/j.annder.2019.02.002.
  2. Leishmaniasis [Internet]. [cited 2021 Feb 23]. Available from:
  3. Chakravarty J, Sundar S. Current and emerging medications for the treatment of leishmaniasis. Expert Opin Pharmacother 2019;20(10):1251–1265. DOI: 10.1080/14656566.2019.1609940.
  4. Bueno-Marí R, Jiménez-Peydró R. Global change and human vulnerability to vector-borne diseases. Front Physiol 2013;4:158. DOI: 10.3389/fphys.2013.00158.
  5. Gradoni L. A brief introduction to leishmaniasis epidemiology. Leishmaniases Old Neglected Trop Dis 2018;1–13. DOI: 10.1007/978-3-319-72386-0_1.
  6. Wilhelm TJ. Visceral leishmaniasis. Chirurg 2019;90(10):833–837. DOI: 10.1007/s00104-019-0994-1.
  7. Murray HW, Berman JD, Davies CR, Saravia NG. Advances in leishmaniasis. [Review] [199 refs]. Lancet 2005;366(9496):1561–1577. DOI: 10.1016/S0140-6736(05)67629-5.
  8. Piscopo TV, Mallia AC. Leishmaniasis. Postgrad Med J 2006;82(972):649–657. DOI: 10.1136/pgmj.2006.047340corr1.
  9. Joshi PB, Kelly BL, Kamhawi S, Sacks DL, McMaster WR. Targeted gene deletion in Leishmania major identifies leishmanolysin (GP63) as a virulence factor. Mol Biochem Parasitol 2002;120(1):33–40. DOI: 10.1016/s0166-6851(01)00432-7.
  10. Kelly BL, Stetson DB, Locksley RM. Leishmania major LACK antigen is required for efficient vertebrate parasitization. J Exp Med 2003;198(11):1689–1698. DOI: 10.1084/jem.20031162.
  11. Gasim S, Elhassan AM, Khalil EAG, Ismail A, Kadaru AMY, Kharazmi A, et al. High levels of plasma IL-10 and expression of IL-10 by keratinocytes during visceral leishmaniasis predict subsequent development of post-kala- azar dermal leishmaniasis. Clin Exp Immunol 1998;111(1):64–69. DOI: 10.1046/j.1365-2249.1998.00468.x.
  12. Bourreau E, Preévot G, Gardon J, Pradinaud R, Launois P. High intralesional interleukin-10 messenger RNA expression in localized cutaneous leishmaniasis is associated with unresponsiveness to treatment. J Infect Dis 2001;184(12):1628–1630. DOI: 10.1086/324665.
  13. Gomes R, Oliveira F. The immune response to sand fly salivary proteins and its influence on Leishmania immunity. Front Immunol 2012;3:1–9. DOI: 10.3389/fimmu.2012.00110.
  14. Kevric I, Cappel MA, Keeling JH. New world and old world leishmania infections: a practical review. Dermatol Clin 2015;33(3):579–593. DOI: 10.1016/j.det.2015.03.018.
  15. Sundar S, Sahu M, Mehta H, Gupta A, Kohli U, Rai M, et al. Noninvasive management of Indian visceral leishmaniasis: clinical application of diagnosis by K39 antigen strip testing at a kala-azar referral unit. Clin Infect Dis 2002;35(5):581–586. DOI: 10.1086/342057.

  16. Islam MZ, Itoh M, Mirza R, Ahmed I, Ekram ARMS, Sarder AH, et al. Direct agglutination test with urine samples for the diagnosis of visceral leishmaniasis. Am J Trop Med Hyg 2004;70(1):78–82. DOI:
  17. Fissore C, Delaunay P, Ferrua B, Rosenthal E, Del Giudice P, Aufeuvre JP, et al. Convenience of serum for visceral leishmaniasis diagnosis by PCR. J Clin Microbiol 2004;42(11):5332–5333. DOI: 10.1128/JCM.42.11.5332-5333.2004.
  18. Ramirez JR, Agudelo S, Muskus C, Alzate JF, Berberich C, Barker D, et al. Diagnosis of cutaneous leishmaniasis in Colombia: the sampling site within lesions influences the sensitivity of parasitologic diagnosis. J Clin Microbiol 2000;38(10):3768–3773. DOI: 10.1128/JCM.38.10.3768-3773.2000.
  19. Arana BA, Roca M, Rizzo NR, Mendoza CE, Kroeger A. Evaluation of a standardized leishmanin skin test in Guatemala. Trans R Soc Trop Med Hyg 1999;93(4):394–396. DOI: 10.1016/s0035-9203(99)90129-3.
  20. Taslimi Y, Zahedifard F, Rafati S. Leishmaniasis and various immunotherapeutic approaches. Parasitology 2018;145(4):497–507. DOI: 10.1017/S003118201600216X.
  21. Roatt BM, de Oliveira Cardoso JM, De Brito RCF, Coura-Vital W, de Oliveira Aguiar-Soares RD, Reis AB. Recent advances and new strategies on leishmaniasis treatment. Appl Microbiol Biotechnol 2020;104(21):8965–8977. DOI: 10.1007/s00253-020-10856-w.
  22. Ghorbani M, Farhoudi R. Leishmaniasis in humans: drug or vaccine therapy? Drug Des Devel Ther 2018;12:25–40. DOI: 10.2147/DDDT.S146521.
  23. Ponte-Sucre A, Gamarro F, Dujardin JC, Barrett MP, López-Vélez R, García-Hernández R, et al. Drug resistance and treatment failure in leishmaniasis: a 21st century challenge. PLoS Negl Trop Dis 2017;11(12):1–24. DOI: 10.1371/journal.pntd.0006052.
  24. Davidson RN, Seaman J, Pryce D, Sondorp HE, Moody A, Bryceson ADM, et al. Epidemic visceral leishmaniasis in Sudan: a randomized trial of aminosidine plus sodium stibogluconate versus sodium stibogluconate alone. J Infect Dis 1993;168(3):715–720. DOI: 10.1093/infdis/168.3.715.
  25. Sundar S, Sinha PK, Rai M, Verma DK, Nawin K, Alam S, et al. Comparison of short-course multidrug treatment with standard therapy for visceral leishmaniasis in India: an open-label, non-inferiority, randomised controlled trial. Lancet 2011;377(9764):477–486. DOI: 10.1016/S0140-6736(10)62050-8.
  26. Cardona-Arias JA, Darío Vélez I, López-Carvajal L. Efficacy of thermotherapy to treat cutaneous leishmaniasis: a meta-analysis of controlled clinical trials. PLoS One 2015;10(5):1–15. DOI: 10.1371/journal.pone.0122569.
  27. Bumb RA, Prasad N, Khandelwal K, Aara N, Mehta RD, Ghiya BC, et al. Long-term efficacy of single-dose radiofrequency-induced heat therapy vs. intralesional antimonials for cutaneous leishmaniasis in India. Br J Dermatol 2013;168(5):1114–1119. DOI: 10.1111/bjd.12205.
  28. López-Carvajal L, Cardona-Arias JA, Zapata-Cardona MI, Sánchez-Giraldo V, Vélez ID. Efficacy of cryotherapy for the treatment of cutaneous leishmaniasis: meta-analyses of clinical trials. BMC Infect Dis 2016;16(1):1–11. DOI: 10.1186/s12879-016-1663-3.
  29. Shamsi Meymandi S, Zandi S, Aghaie H, Heshmatkhah A. Efficacy of CO2 laser for treatment of anthroponotic cutaneous leishmaniasis, compared with combination of cryotherapy and intralesional meglumine antimoniate. J Eur Acad Dermatol Venereol 2011;25(5):587–591. DOI: 10.1111/j.1468-3083.2010.03781.x.
  30. Alvar J, Croft SL, Kaye P, Khamesipour A, Sundar S, Reed SG. Case study for a vaccine against leishmaniasis. Vaccine 2013;31(Suppl. 2):B244–B249. DOI: 10.1016/j.vaccine.2012.11.080.
  31. Khamesipour A, Dowlati Y, Asilian A, Hashemi-Fesharki R, Javadi A, Noazin S, et al. Leishmanization: use of an old method for evaluation of candidate vaccines against leishmaniasis. Vaccine 2005;23(28):3642–3648. DOI: 10.1016/j.vaccine.2005.02.015.
  32. Handman E. Leishmaniasis: current status of vaccine development. Clin Microbiol Rev 2001;14(2):229–243. DOI: 10.1128/CMR.14.2.229-243.2001.
  33. De Brito RCF, Cardoso JMDO, Reis LES, Vieira JF, Mathias FAS, Roatt BM, et al. Peptide vaccines for leishmaniasis. Front Immunol 2018;9(May):1043. DOI: 10.3389/fimmu.2018.01043.
  34. Akbari M, Oryan A, Hatam G. Application of nanotechnology in treatment of leishmaniasis: a review. Acta Trop 2017;172(January):86–90. DOI: 10.1016/j.actatropica.2017.04.029..
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