LEISHMANIASIS TYPES n A Cutaneous n B Mucocutaneous

LEISHMANIASIS

TYPES n A) Cutaneous n B) Mucocutaneous n C) Visceral

Life Cycle

The parasite in blood stream n n n * Is transmitted from animals to humans by the bite of infected sand fly. * Diagnosed by the presence of parasite in biopsy from skin. * Treatment is limited due to toxicities & failure of drugs.

Sodium Stibogluconate n Pentavalent antimonial drug

Pharmacokinetics n n n Not absorbed orally Given IV/ IM for 20 days for cutaneous leishmaniasis & 28 days for visceral and mucocutaneous disease. Distributed in extravascular compartement.

n Partially metabolized n Excreted in urine

Mechanism Of Action n Unknown n Production of oxygen free radicals

Adverse Effects n n n GIT upset Fever, headache, arthralgia , rash. IMI----( local pain & sterile abscess). QT prolongation. Hemolytic anaemia

Pentamidine n n Alternative to Na stibogluconate for the treatment of visceral leishmaniasis. For cutaneous lesion

Pharmacokinetics n n n Not absorbed orally Given IV/ IM. Accumulative drug & eliminated slowly in urine ( elimination half-life 12 days). Not effectively cross blood brain barrier Can be inhaled as a nebulized powder.

Mechanism of Action n Unknown

Clinical uses n n Pneumocystosis Prophylaxis against pneumocystosis in immunocompromised individuals. African trypanosomiasis ( sleeping sickness). Alternative to sodium stibogluconate for visceral leishmaniasis.

Adverse Effects n n Rapid IVI can lead to severe hypotension, tachycardia , dizziness, dyspnea ( should be given slowly over 2 hours). IMI – pain & sterile abscess

n n n Pancreatic toxicity( acute pancreatitis) Hypoglycemia Hyperglycemia Reversible renal insufficiency Rash Metallic taste

n n n Fever Thrombocytopenia Cardiac arrhythmias GIT upset Cough, dyspnea, bronchospasm ( with the inhaled drug ) Headache, Arthralgia

Miltefosine n n n An alkylphosphocholine analog Used for the treatment of visceral leishmaniasis Given orally

Adverse Effects n Vomiting & diarrhea n Elevation in liver enzymes n Teratogenic

Amphotericin B n n Antifungal drug Used as alternative therapy for visceral leishmaniasis.