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71. Secondary prophylaxis is NOT recommended for initial management
in persons with VL who have not manifested a relapse (W-L).
Remark: Immunosuppressed persons with VL who are not coinfected with HIV
typically have higher response rates to initial treatment and lower recurrence rates
than HIV-coinfected persons.
72. Routine serologic screening of organ donors from leishmaniasis-
endemic areas is NOT recommended. If an available donor is known
to be seropositive, it is advisable to perform clinical and laboratory
monitoring of the recipient in the post-transplant period rather than
to reject the organ for transplant (S-L).
73. The Panel suggests that clinicians NOT routinely perform
diagnostic testing to assess persons for evidence of asymptomatic
visceral infection, including persons who have lived or traveled
in leishmaniasis-endemic regions (Figure 3) and are considering
organ transplantation or initiation of therapy with biologic
immunomodulating agents. Immunosuppressed persons known or
found to be asymptomatically infected and those with a history of VL
warrant close monitoring. Neither preemptive treatment nor primary
prophylaxis for VL in asymptomatically infected persons is suggested
(W-VL).
74. Immunosuppressed persons with VL who are not coinfected with HIV
should be monitored for ≥1 year (ideally lifelong or until effective
immune reconstitution) to assess for posttreatment relapse. During
clinical follow-up, assess for symptoms and, if present, pursue
parasitologic confirmation of relapse (S-VL).
75. Confirmed VL therapeutic failure typically can be managed by
retreatment using L-AmB at the same or a higher total dose (S-VL).
Remark: Pentavalent antimonials could be used in some persons with VL under close
follow-up.
76. The Panel suggests that CL/ML associated with the use of tumor
necrosis factor (TNF)-alpha antagonist therapy be managed with
systemic therapy and standard drug regimens for the pertinent
setting/species (eg, geographic area where the infection was
acquired) (W-VL).
Remark: Withdrawal of TNF-α antagonists during antileishmanial therapy may be
appropriate: the risks, benefits, and feasibility of this action should be assessed on a
case-by-case basis.
