Blum J, Desjeux P, Schwartz E, Beck B, Hatz C
Swiss Tropical Institute, Socinstrasse 57, 4002 Basel, Switzerland.
J Antimicrob Chemother. 2004 Feb;53(2):158-66. doi: 10.1093/jac/dkh058. Epub 2004 Jan 16.
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.
利什曼病在五大洲的88个国家呈地方性流行。全球每年报告100万至150万例皮肤利什曼病病例。在过去10年中，记录在案的病例急剧增加。根据地理分布，皮肤利什曼病分为旧世界利什曼病和新世界利什曼病。过去，可从地理环境推断物种，或通过培养和同工酶分析来确定。最近开发且现已广泛应用的聚合酶链反应（PCR）技术可实现快速诊断并确定大多数物种，从而实现针对性治疗。旧世界的物种大多引起良性且通常自限性的皮肤疾病，而美洲的物种则会导致从良性到严重表现的广泛病症，包括黏膜受累。治疗反应因物种而异。因此，建议采用针对物种的方法。本文介绍并讨论了全身和局部治疗药物的应用、用法及不良反应。提出了局部或全身治疗的适应证。还提及了正在研究的药物。针对每个最重要的物种给出了已发表治疗方案的概述和治疗建议。给出了得出这些建议的研究的证据水平。
