1. LEISHMANIASIS

2. TYPES A) Cutaneous B) Mucocutaneous C) Visceral

5. Life Cycle

6. The parasite in blood stream * Is transmitted from animals to humans by the bite of infected sand fly. * Diagnosed by the presence of parasite in biopsy from skin. * Treatment is limited due to toxicities & failure of drugs.

7. Sodium Stibogluconate Pentavalent antimonial drug

8. Pharmacokinetics Not absorbed orally Given IV/ IM for 20 days for cutaneous leishmaniasis & 28 days for visceral and mucocutaneous disease. Distributed in extravascular compartement.

9. Partially metabolized Excreted in urine

10. Mechanism Of Action Unknown Production of oxygen free radicals

11. Adverse Effects GIT upset Fever, headache, arthralgia, rash. IMI----( local pain & sterile abscess). QT prolongation. Hemolytic anaemia

12. Pentamidine Alternative to Na stibogluconate for the treatment of visceral leishmaniasis. For cutaneous lesion

13. Pharmacokinetics Not absorbed orally Given IV/ IM. Accumulative drug & eliminated slowly in urine ( elimination half-life 12 days). Not effectively cross blood brain barrier Can be inhaled as a nebulized powder.

14. Mechanism of Action Unknown

15. Clinical uses Pneumocystosis Prophylaxis against pneumocystosis in immunocompromised individuals. African trypanosomiasis ( sleeping sickness). Alternative to sodium stibogluconate for visceral leishmaniasis.

16. Adverse Effects Rapid IVI can lead to severe hypotension, tachycardia, dizziness, dyspnea ( should be given slowly over 2 hours). IMI – pain & sterile abscess

17. Pancreatic toxicity( acute pancreatitis) Hypoglycemia Hyperglycemia Reversible renal insufficiency Rash Metallic taste

18. Fever Thrombocytopenia Cardiac arrhythmias GIT upset Cough, dyspnea, bronchospasm ( with the inhaled drug ) Headache, Arthralgia

19. Miltefosine An alkylphosphocholine analog Used for the treatment of visceral leishmaniasis Given orally

20. Adverse Effects Vomiting & diarrhea Elevation in liver enzymes Teratogenic

21. Amphotericin B Antifungal drug Used as alternative therapy for visceral leishmaniasis.