Combination therapy for leishmaniasis shows promise

May 05, 2016, 4:00am

As tropical diseases piggyback to the U.S. with travelers, the armamentarium for treating them expands.

Anyone who keeps in touch with current topics knows the news has been rife with reports of the spread of illnesses beyond their indigenous home geographies. With global travel what it is, plenty of bad players can hitch a ride to all points across the world when travelers return home.

While the Zika virus has dominated headlines recently, it certainly is not the first condition to infect people and globe-trot to geographies where it’s infrequently seen. It’s easy to lose sight of the other bad players in the arena-those conditions are plenty important to the patients whom they afflict.

Leishmaniasis, a single-celled parasite, is one such condition. Cutaneous leishmaniasis is native to parts of the tropics, subtropics, southern Europe, and parts of Asia and Africa, where the tiny vector-the phlebotomite sandfly-reigns. However, those infected with the parasite can experience tenacious symptoms long after they’ve vacated the offending bug’s homeland.

Treatment options are limited. Pentavalent antimony therapy is considered a first line of therapy for patients suffering from leishmaniasis infections, and thermotherapy is a second line. Miltefosine, an oral medication that interferes with parasite membrane protein kinase signaling, has been used to treat the condition internationally for many years, but has only recently been approved for use in the United States. And, while it’s as much as 90% effective, it is not a benign treatment – it carries a pregnancy category X black box warning. Its use in women of childbearing age must be carefully planned, administered, and monitored.

Related: Leishmaniasis comes to the U.S.

Next: A stubborn case, resolved

 

A stubborn case, resolved

Another recent development was described in a research paper published in the December 2015 issue of Lasers in Surgery and Medicine, the official publication of the American Society for Laser Medicine and Surgery. The study suggests that a new combination treatment modality could join the arsenal against the disease. The manuscript, titled, “Ablative fractional laser resurfacing with topical paromomycin as adjuvant treatment for a recalcitrant cutaneous leishmaniasis wound,” documents a successful case study.

The patient, who had acquired the condition while traveling in Israel, responded well to a six-week course of oral fluconazole with topical paromomycin, with all but one of her lesions healing.

The recalcitrant lesion was subsequently treated with ablative microfractionated 10,600-nm carbon dioxide laser (Ultrapulse Encore Deep Fx, Lumens, LTD., Yokneam, Israel) and topical paromomycin applied immediately after the laser surgery, then continued daily for a total of three months. The infection resolved and the lesion cleared with minimal scarring, providing a positive cosmetic outcome.

While this study examined only a single patient, it points to a promising potential treatment option that may be able to help patients who have lesions that have not responded completely via other treatment approaches. And that, hopefully, could help to keep leishmaniasis infections in check, even as global travel increases the likelihood that it won’t be keeping to its home territory.