Minodier Philippe, Parola Philippe
Pediatric Emergency Unit, CHU Nord, Chemin des Bourrelly, 13915 Marseille Cedex 20, France.
Travel Med Infect Dis. 2007 May;5(3):150-8. doi: 10.1016/j.tmaid.2006.09.004. Epub 2006 Oct 31.
The causative species of cutaneous leishmaniasis determines the clinical features and courses, and treatments. Intralesional or systemic antimonials are the gold standard for the treatment of these diseases. However, as for visceral leishmaniasis, other therapeutic options appear promising. Paromomycin ointments are effective in Leishmania major, L. tropica, L. mexicana, and L. panamensis lesions. In L. braziliensis localized leishmaniasis, both paromomycin and imiquimod may be topically applied. Oral fluconazole and zinc sulfate are useful in L. major. Oral azithromycin, effective in vitro and in mice, needs further investigation in human leishmaniasis. On the contrary, data with oral itraconazole are disappointing. Oral miltefosine, which is very effective in visceral leishmaniasis caused by L. donovani, appears ineffective in L. major and L. braziliensis infections. Intramuscular pentamidine is required for L. guyanensis cutaneous leishmaniasis, for which systemic antimony is not effective. Liposomal amphotericin B could be an alternative to antimony in south American cutaneous leishmaniasis with mucosal involvement (especially L. braziliensis and L. guyanensis infections).
皮肤利什曼病的致病物种决定了其临床特征、病程及治疗方法。病灶内或全身性使用锑剂是治疗这些疾病的金标准。然而，对于内脏利什曼病，其他治疗选择似乎很有前景。巴龙霉素软膏对硕大利什曼原虫、热带利什曼原虫、墨西哥利什曼原虫和巴拿马利什曼原虫引起的病灶有效。在巴西利什曼原虫引起的局限性利什曼病中，巴龙霉素和咪喹莫特均可局部应用。口服氟康唑和硫酸锌对硕大利什曼原虫有效。口服阿奇霉素在体外和小鼠实验中有效，但在人类利什曼病中的应用尚需进一步研究。相反，口服伊曲康唑的数据令人失望。口服米替福新对杜氏利什曼原虫引起的内脏利什曼病非常有效，但对硕大利什曼原虫和巴西利什曼原虫感染似乎无效。对于圭亚那利什曼原虫引起的皮肤利什曼病，由于全身性锑剂无效，需肌肉注射喷他脒。在南美洲伴有黏膜受累的皮肤利什曼病（尤其是巴西利什曼原虫和圭亚那利什曼原虫感染）中，脂质体两性霉素B可作为锑剂的替代药物。
