Palumbo E
Department of Pediatric, Hospital of Sondrio, Sondrio, Italy.
Minerva Pediatr. 2010 Aug;62(4):389-95.
Leishmaniasis is distributed worldwide and 13 million people are estimated to be infected, with about 1.8 million new cases each year. Approximately 50% of these patients are children. It should be suspected in children who present with specific manifestations and the diagnosis should be established, mainly by the demonstration of leishmania in tissue specimens. Molecular techniques could soon change this situation considering the promise they have shown in the diagnosis of other infectious diseases. Several advances in the treatment of visceral leishmaniasis have been accomplished during the past few years. All antileishmanial drugs are toxic and most have to be used parenterally for prolonged period. The therapy has been further complicated by large number of infected children and declining effectiveness of pentavalent antimonial compounds. Although the lipid formulations of amphotericin B are an important advance in therapy, their high cost precludes their use. Miltefosine, a phosphocholine analogue originally developed as anti-malignant drug, has been found to be highly active against leishmania in vitro and in animal model. The aim of this review is to evidence the recent advances in diagnosis and treatment of visceral leishmaniasis.
利什曼病在全球范围内均有分布，据估计有1300万人受到感染，每年新增病例约180万。其中约50%的患者为儿童。对于出现特定症状的儿童应怀疑患有该病，诊断主要通过在组织标本中发现利什曼原虫来确立。鉴于分子技术在其他传染病诊断中所展现出的前景，其可能很快改变这一现状。在过去几年里，内脏利什曼病的治疗取得了一些进展。所有抗利什曼原虫药物都有毒性，大多数必须长期通过肠胃外途径使用。大量受感染儿童以及五价锑化合物疗效的下降使治疗变得更加复杂。尽管两性霉素B的脂质制剂在治疗方面是一项重要进展，但其高昂的成本使其无法广泛应用。米替福新是一种最初作为抗癌药物研发的磷酸胆碱类似物，已发现在体外和动物模型中对利什曼原虫具有高度活性。本综述的目的是阐述内脏利什曼病在诊断和治疗方面的最新进展。
