IDSA GUIDELINES Bundle (free trial)

Leishmaniasis

IDSA GUIDELINES Apps brought to you free of charge courtesy of Guideline Central. All of these titles are available for purchase on our website, GuidelineCentral.com. Enjoy!

Issue link: https://eguideline.guidelinecentral.com/i/774306

Contents of this Issue

Navigation

Page 14 of 39

15 Mucosal Leishmaniasis (CL) 44. All persons with clinically manifest, metastatic, American ML should receive systemic antileishmanial therapy, with the goals of preventing morbidity (eg, disfigurement) and mortality (eg, from aspiration pneumonia or respiratory obstruction) (S-L). 45. Before treatment is initiated, a complete examination of the naso- oropharyngeal/laryngeal mucosa should be conducted by a specialist to assess the anatomic extension and clinical severity of the mucosal disease, which have prognostic implications (S-M). 46. The Panel recommends inpatient monitoring and prophylactic corticosteroid therapy for persons with laryngeal/pharyngeal disease and increased risk for respiratory obstruction, as indicated by symptoms and otolaryngologic/radiologic examinations, because of the potential for inflammatory reactions after initiation of antileishmanial therapy (S-L). 47. The choice of antileishmanial agent, dose, and duration of therapy for persons with ML should be individualized (Table 3) (S-M). Remarks: The traditional options for ML include treatment with a pentavalent antimonial (SbV) compound (20 mg SbV/kg daily, IV or IM, for 28–30 days) or with amphotericin B deoxycholate (0.5–1.0 mg/kg per dose, IV, daily or every other day, for a cumulative total of ~20–45 mg/kg ). More recently, on the basis of comparatively limited data, the armamentarium has expanded to include lipid formulations of amphotericin B (typically, liposomal amphotericin B [L-AmB], with a cumulative total dose ranging widely from ~20–60 mg/kg ), as well as the oral agent miltefosine (~2.5 mg/kg per day [maximum, 150 mg/day] for28 days). Visceral Leishmaniasis (VL) VL is potentially life threatening and requires prompt evaluation and treatment. The potential for VL to be life threatening and the high response rate associated with L-AmB therapy justify its side effects and cost. The objective of treatment is clinical healing, not parasitologic cure. Treatment does not necessarily result in parasitologic cure, as evidenced by cases of relapse, especially in the context of immunosuppression. Some experts consider all persons with symptomatic VL to be immunocompromised, some perhaps without an identified immune defect. (In these guidelines, immunocompetent VL refers to persons with VL without an identified immune defect.) 48. The Panel recommends that persons with clinical abnormalities compatible with VL and laboratory evidence of VL be treated (Table 3) (S-M).

Articles in this issue

Archives of this issue

view archives of IDSA GUIDELINES Bundle (free trial) - Leishmaniasis