Ecole Nationale Supérieure Vétérinaire d'Alger, BP 161, Hassan Badi El-Harrach, Alger, Algeria.
Parasitol Res. 2011 Nov;109(5):1225-32. doi: 10.1007/s00436-011-2555-5. Epub 2011 Jul 29.
Leishmania is the causative agent of various forms of leishmaniasis, a significant cause of morbidity and mortality. The clinical manifestations of the disease range from self-healing cutaneous and mucocutaneous skin ulcers to a fatal visceral form named visceral leishmaniasis or kala-azar. In the absence of any effective vaccine, the only means to treat and control leishmaniasis is affordable medication. The treatment choice is essentially directed by economic considerations; therefore, for a large majority of countries, chemotherapy relies only on the use of cheaper antimonial compounds. The emergence of antimonial therapy failure in India linked to proven parasite resistance has stressed questions about selective factors as well as transmission risk of drug resistance. Unfortunately, in most parts of the world, the frequency of parasite antimony resistance linked to treatment failure is unknown because of a lack of information on Leishmania antimony susceptibility. This information is crucial for addressing the risk of selection and transmission of drug-resistant parasites, particularly in areas where antimony is the only chemotherapeutic alternative. However, the poor knowledge about factors that favor selection of resistant parasites, the multiplicity of the agents that can play a role in the in vivo antileishmanial activity of antimony, and the lack of a standard protocol to diagnose and survey parasite resistance all contribute to insufficient monitoring of antimony resistance. In this review, we discuss on the factors potentially involved in the selection of antimony resistance in the field and discuss on the methods available for its diagnosis.
利什曼原虫是各种利什曼病的病原体，是发病率和死亡率的重要原因。该疾病的临床表现范围从自我愈合的皮肤和粘膜溃疡到致命的内脏形式，称为内脏利什曼病或黑热病。在没有任何有效疫苗的情况下，治疗和控制利什曼病的唯一手段是负担得起的药物。治疗选择基本上取决于经济考虑因素；因此，对于大多数国家来说，化疗仅依赖于使用更便宜的锑化合物。印度出现的锑治疗失败与已证明的寄生虫耐药性有关，这引发了人们对选择因素以及耐药性传播风险的质疑。不幸的是，由于缺乏有关利什曼原虫对锑敏感性的信息，在世界大部分地区，与治疗失败相关的寄生虫对锑的耐药性的频率尚不清楚。该信息对于解决耐药寄生虫选择和传播的风险至关重要，特别是在仅使用锑作为化学治疗替代方案的地区。然而，对有利于选择耐药寄生虫的因素的了解不足、可能在锑的体内抗利什曼原虫活性中起作用的药物种类繁多，以及缺乏诊断和调查寄生虫耐药性的标准方案，都导致对锑耐药性的监测不足。在这篇综述中，我们讨论了在现场选择锑耐药性的潜在因素，并讨论了诊断耐药性的可用方法。
