Schwartz Eli, Hatz Cristoph, Blum Johannes
The Center for Geographic Medicine and Tropical Diseases, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
Lancet Infect Dis. 2006 Jun;6(6):342-9. doi: 10.1016/S1473-3099(06)70492-3.
As travel to Latin America has become increasingly common, cutaneous leishmaniasis is increasingly seen among returning travellers--eg, the number of observed cases has doubled in the Netherlands and tripled in the UK in the past decade. A surprisingly high proportion of cases were acquired in rural or jungle areas of the Amazon basin in Bolivia. The clinical manifestations range from ulcerative skin lesions (cutaneous leishmaniasis) to a destructive mucosal inflammation (mucocutaneous leishmaniasis), the latter usually being a complication of infection with Leishmania (Viannia) braziliensis. PCR is now the diagnostic method of choice, since it has a high sensitivity and gives a species-specific diagnosis, allowing species-specific treatment. Treatment of cutaneous leishmaniasis aims to prevent mucosal invasion, to accelerate the healing of the skin lesion(s), and to avoid disfiguring scars. Pentavalent antimonials drugs are still the drug of choice for many patients. However, a high rate of adverse events, length of treatment, and relapses in up to 25% of cases highlight the limitations of these drugs. Although only used in a small number of patients thus far, liposomal amphotericin B shows promising results. Further studies are needed to find efficacious and better-tolerated drugs for new world leishmaniasis.
随着前往拉丁美洲的旅行日益普遍，皮肤利什曼病在归国旅行者中越来越常见，例如，在过去十年中，荷兰观察到的病例数量翻了一番，英国则增至三倍。令人惊讶的是，相当高比例的病例是在玻利维亚亚马逊盆地的农村或丛林地区感染的。临床表现从溃疡性皮肤病变（皮肤利什曼病）到破坏性的黏膜炎症（黏膜皮肤利什曼病）不等，后者通常是巴西利什曼原虫（维安亚利什曼原虫）感染的并发症。聚合酶链反应（PCR）现在是首选的诊断方法，因为它具有高灵敏度，能进行种特异性诊断，从而实现针对性治疗。皮肤利什曼病的治疗旨在防止黏膜侵袭、加速皮肤病变愈合并避免留下毁容性疤痕。五价锑剂药物仍是许多患者的首选药物。然而，高达25%的病例出现的高不良事件发生率、长疗程和复发率凸显了这些药物的局限性。尽管到目前为止仅在少数患者中使用，脂质体两性霉素B显示出了有前景的效果。需要进一步研究以找到治疗新大陆利什曼病的有效且耐受性更好的药物。
