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LEISHMANIASIS

LEISHMANIASIS. Dr.Abdul latif Mahesar Dept.of medical pharmacology King Saud university. Leishmaniasis is a parasitic disease caused by microsopcopic protozoans of genus leishmania It was identified by a British medical officer Sir William boog leishman .

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LEISHMANIASIS

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  1. LEISHMANIASIS Dr.Abdul latif Mahesar Dept.of medical pharmacology King Saud university

  2. Leishmaniasis is a parasitic disease caused by microsopcopicprotozoans of genus leishmania • It was identified by a British medical officer Sir William boogleishman. • It occurs in Mediterranean region, Africa , central and south America.

  3. The parasite is in blood stream • It is transmitted from animals to humans and between humans by the bite of infected sand fly • It is diagnosed by the presence of parasite in biopsy from skin lesions • Its treatment is limited due to toxicities and failure of the drugs.

  4. It can cause visceral disease mainly enlargement of liver and spleen with anemia and intermittent fever, as well as cutaneous and mucocutaneous lesions.

  5. Sodium stibogluconate is a primary drug for all forms of the disease. • Cutaneous lesions can also be treated by fluconazole and metronidazole . • Mucocutaneous disease can be treated by amphotericin B

  6. Types of leishmaniasis a) Cutaneous b) Mucocutaneous c) Visceral

  7. life cycle • The sand fly transfer the flagellated promestigote form of protozoa.This is rapidly phagocytized by macrophages. • In macrophage the promastigote rapidly changes to nonflagellated amastigote and multiply ,killing cell. • The newly released amastigote are again phagocytized and the cycle continues

  8. Treatment • It is treated by antimonials as conventional therapy. • and with pentamidine and amphotericin as backup therapy.

  9. SODIUM STIBOGLUCONATE Pentavalent antimonials include: • Sodium stibogluconate • Meglumine antimonate • Generally considered as first line agents for cutaneous and visceral leishmaniasis

  10. Mechanism of action: • It is unknown • Evidence for inhibition of glycolysis in the parasite .

  11. Pharmacokinetics • It does not get absorbed orally • It is administered parenterally in a dose of 20mg/kg /day /IM or slow I/V infusion for 20 days for cutaneous leishmaniasis and 28 days for visceral and mucocutaneous disease. • It can be diluted in 5%dextrose for ease of administration • Cardiac monitoring should be performed ,if central chest pain occurs,drug must be stopped.

  12. It is distributed in extra vascular compartment • It is excreted in urine rapidly ,70 % being excreted with in 6 hours. • Half life ranges between 2 to 24 hours. • More than one course may be required.

  13. ADVERSE EFFECTS: • Pain at the site of injection site • Gastrointestinal upset • Cardiac arrhythmias ,Brdycardia ,hypotension • Myalgia Fever • Cough Headache • Arthralgia • serum amylase may increase to 4 time the normal. • Renal and hepatic function should be monitored regularly • Resistance is frequent

  14. PENTAMIDINE ISETHIONATE • It is used as an alternative to Na stibogluconate for the treatment of visceral leishmaniasis and sometimes used for cutaneous lesion , but not routinely. • It is given in a dose of 2-4 mg/kg Im daily or every other day up to 15 days

  15. Pharmacokinetics • It is not absorbed orally • It is accumulated and eliminated very slowly in urine • It has a half life of 12 days

  16. Its mechanism of action is unknown

  17. Adverse effects • Pain at the site of injections • Hypotension • tachycardia • Dizziness • Dyspnea • Pancreatic toxicity hypoglycemia

  18. Reversible renal insufficiency • GIT disturbances • Cardiac arrhythmia • Abnormal liver function tests • it can also be used for the treatment of pneumocystosis and African trypanosomiasis

  19. MILTEFOSINE • It is alkylphosphocholine analog • It is used in the treatment of visceral leishmaniasis • it is orally effective and administered 2.5mg/kg daily for adults

  20. Adverse effects • Gastrointestinal disturbances • Elevation in liver transaminase • Teratogenic

  21. AmAmphotericin B photericin B an antifungal drug which can be used as an alternative therapy for visceral leishmaniasis. liposomal form has shown excellent efficacy.3mg/kg/day on day1-5, 14 and 21.non liposomal 1mg/kg/day i.v on alternate day for 30 days

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