1. LEISHMANIASIS Dr.Abdul latif Mahesar Dept.of medical pharmacology
King Saud university
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2. Leishmaniasis is a parasitic disease caused by microsopcopic protozoans of genus leishmania
It was identified by a British medical officer Sir William boog leishman.
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.
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4. It can cause visceral disease mainly enlargement of liver and spleen with anemia and intermittent fever, as well as cutaneous and mucocutaneous lesions.
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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
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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
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12. Treatment It is treated by antimonials as conventional therapy.
and with pentamidine and amphotericin as backup therapy.
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13. SODIUM STIBOGLUCONATE
Pentavalent antimonials include:
Sodium stibogluconate
Meglumine antimonate
Generally considered as first line agents for cutaneous and visceral leishmaniasis
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14. Mechanism of action: It is unknown
Evidence for inhibition of glycolysis in the parasite .
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15. 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.
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16. 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.
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17. 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
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18. 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
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19. Pharmacokinetics It is not absorbed orally
It is accumulated and eliminated very slowly in urine
It has a half life of 12 days
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20. Its mechanism of action is unknown
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21. Adverse effects Pain at the site of injections Hypotension tachycardia
Dizziness
Dyspnea
Pancreatic toxicity hypoglycemia
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22. Reversible renal insufficiency GIT disturbances Cardiac arrhythmia
Abnormal liver function tests
it can also be used for the treatment of pneumocystosis and African trypanosomiasis
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23. 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
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24. Adverse effects Gastrointestinal disturbances
Elevation in liver transaminase
Teratogenic
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25. Am Amphotericin 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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