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 9 of 39

10 Treatment Cutaneous Leishmaniasis (CL) Treatment recommendations for CL are not straightforward; many CL infections may clinically resolve without treatment. For CL, the interrelated goals of treatment include minimizing local tissue damage and cosmetic or functional consequences, accelerating the rate of healing, reducing the likelihood of local recurrences, and decreasing the risk of developing mucosal disease caused by parasites in the Viannia subgenus. The therapeutic strateg y depends in part on the infecting species or, as a proxy, whether the infection was acquired in the Americas (New World cutaneous leishmaniasis; NWCL) or elsewhere (Old World cutaneous leishmaniasis; OWCL). Local therapy may be an option for some cases of CL, and use of systemic therapy may be indicated or prudent for others. 23. After a careful diagnostic evaluation in which neither leishmaniasis nor another diagnosis is confirmed, empiric treatment may be indicated on the basis of an individualized risk-benefit assessment (W-VL). Remark: This should be discussed with the patient and reevaluated periodically, taking into account the clinical evolution. 24. The Panel recommends that immunocompetent persons with skin lesions that are caused by infection with Leishmania species that are not associated with increased risk for ML, that are defined as clinically simple lesions (Table 1), and that are healing spontaneously may be observed without treatment if the patient concurs with this management (S-M). 25. For persons with CL when the Leishmania species is not known but the infection was not acquired in an increased ML-risk region (Table 1, Figure 2), treatment of clinically simple or healing skin lesions is not required in an immunocompetent patient who concurs with this management (S-L; E.C. dissents, recommending that all persons with NWCL receive treatment). Remark: See Recs. 67–69 and Recs. 70–77 regarding the management of CL in immunocompromised persons. 26. The Panel suggests that systemic treatment be offered for persons even with healing/recently healed CL lesions caused by increased ML-risk species or when the species is unknown but the infection was acquired in an increased ML-risk region. Risks and benefits of such treatment should be discussed with the patient (W-L). Remark: In some cases, watchful waiting, with vigilance for signs and symptoms of ML, may be a reasonable approach.

Articles in this issue

Archives of this issue

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