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<b>Subject:</b> Fwd: PRO/AH/EDR> Leishmaniasis - USA: new guidelines, IDSA</font>
<div class="gmail_quote"> ubject: PRO/AH/EDR> Leishmaniasis - USA: new guidelines, IDSA<br>
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<br>
LEISHMANIASIS - USA: NEW GUIDELINES, INFECTIOUS DISEASES SOCIETY OF<br>
AMERICA<br>
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<br>
Date: Tue 15 Nov 2016<br>
Source: Infectious Diseases Society of America (IDSA) press release<br>
[edited]<br>
<<a href="http://www.idsociety.org/Press_Release_11_15_2016/" rel="noreferrer" target="_blank">http://www.idsociety.org/Pres<wbr>s_Release_11_15_2016/</a>><br>
<br>
<br>
Driven by burgeoning ecotourism and military campaigns in Iraq and<br>
Afghanistan, a parasitic infection called leishmaniasis is showing up<br>
in more US patients, often stumping doctors. Rapid diagnostic tests<br>
and innovative treatments are among the strategies to address<br>
leishmaniasis highlighted in new guidelines released by the Infectious<br>
Diseases Society of America (IDSA) and the American Society of<br>
Tropical Medicine and Hygiene (ASTMH) and published in the journal<br>
Clinical Infectious Diseases [see reference below].<br>
<br>
The bite of the nearly invisible sand fly - 1/3 the size of a<br>
mosquito - transmits the leishmania parasite. The parasite is found<br>
in more than 90 countries around the world - including Mexico and<br>
those in Central and South America, Asia, Africa, the Middle East, and<br>
southern Europe.<br>
<br>
The infection rarely occurs in the United States, although a few cases<br>
have been reported to have been acquired in Texas and Oklahoma. The<br>
growth of travelers, soldiers, and immigrants with leishmaniasis being<br>
seen by US doctors and the complicated diagnosis and management of the<br>
disease drove the creation of these guidelines, the 1st in the United<br>
States.<br>
<br>
"Leishmaniasis is an increasingly common infection in ecotourists<br>
traveling to Central and South America. Travelers visiting the jungle<br>
in the Amazon basin have a high likelihood of being exposed," said<br>
Naomi E Aronson, MD, lead author of the guidelines. "The cutaneous and<br>
mucosal forms of the infection cause serious scarring and visceral<br>
leishmaniasis can be deadly, so timely diagnosis and treatment managed<br>
by an infectious diseases physician is vital. Because it's still<br>
relatively uncommon in the United States, many doctors are unfamiliar<br>
with leishmaniasis and don't suspect it when diagnosing patients.<br>
<br>
The sore at the site of an infected sand fly bite often is painless<br>
and symptoms of the infection may not show up for a month or longer,<br>
further complicating the diagnosis. More than 20 types of leishmania<br>
parasites cause human infection.<br>
<br>
The 3 main clinical syndromes, often determined by the specific<br>
parasite, are:<br>
- cutaneous leishmaniasis (CL): CL causes skin sores, such as bumps or<br>
lumps that may turn into ulcers with a central crater or scab over.<br>
This is the commonest type of leishmaniasis, with an estimated 700 000<br>
to 1.2 million cases worldwide every year, according to the Centers<br>
for Disease Control and Prevention (CDC).<br>
- mucosal leishmaniasis (ML): CL can metastasize, or spread, to mucous<br>
membranes, especially the mouth and nose, resulting in ML. ML most<br>
often occurs when the patient is infected by leishmania parasites from<br>
Central or South America. Untreated, ML can cause serious scarring and<br>
deformity.<br>
- visceral leishmaniasis (VL): the most serious form, active VL is a<br>
systemic infection that is almost always fatal if not treated.<br>
Symptoms include weeks to months of high fevers, significant weight<br>
loss, an enlarged spleen and low blood counts. CDC estimates there are<br>
200 000 to 400 000 new cases of VL a year.<br>
<br>
When doctors see infections with these symptoms, they should ask if<br>
the patient has traveled outside of North America, Dr Aronson notes.<br>
<br>
CL can be tested by polymerase chain reaction (PCR) or by doing a<br>
culture to identify the type of leishmania and determine how<br>
aggressively it should be treated. A blood test called rK39 provides a<br>
rapid result if VL is suspected, which would be confirmed with PCR or<br>
culture.<br>
<br>
Oral miltefosine was approved by the Food and Drug Administration<br>
(FDA) in 2014 for specific cases of cutaneous, mucosal, and visceral<br>
leishmaniasis. "It may become a game-changer for treating<br>
leishmaniasis as it is a pill that can be used for all 3 leishmaniasis<br>
syndromes, depending on the parasite species responsible for the<br>
infection," said Dr Aronson.<br>
<br>
In addition, the ThermoMed(TM) [heat therapy] device can be used to<br>
heat treat CL. FDA-approved liposomal amphotericin B is given<br>
intravenously (IV) for VL. While more than 80 per cent effective,<br>
these therapies don't always eradicate the parasite, and sometimes<br>
additional treatment is necessary.<br>
<br>
Despite the name, the fly that transmits the parasite also lives in<br>
rotting vegetation in jungle areas. The sand fly most often bites<br>
exposed skin at night, transmitting the parasite. While there are no<br>
vaccines or preventive medications for leishmaniasis, people traveling<br>
to areas where the parasite exists should use protective measures to<br>
avoid infection. That includes wearing protective clothing (long<br>
sleeves and pants), applying insect repellents containing DEET, and<br>
using insecticide-impregnated bed nets.<br>
<br>
[Reference<br>
Aronson N, Herwaldt BL, Libman M, et al. Diagnosis and treatment of<br>
leishmaniasis: clinical practice guidelines by the Infectious Diseases<br>
Society of America (IDSA) and the American Society of Tropical<br>
Medicine and Hygiene (ASTMH). Clin Infect Dis. 2016; doi:<br>
10.1093/cid/ciw670. First published online 14 Nov 2016; available at<br>
<<a href="http://cid.oxfordjournals.org/content/early/2016/11/03/cid.ciw670.full" rel="noreferrer" target="_blank">http://cid.oxfordjournals.org<wbr>/content/early/2016/11/03/cid.<wbr>ciw670.full</a>>]<br>
<br>
--<br>
communicated by:<br>
ProMED-mail<br>
<<a href="mailto:promed@promedmail.org" target="_blank">promed@promedmail.org</a>><br>
<br>
[ProMED-mail posts extensively on leishmaniasis worldwide (see<br>
postings in 2016 listed below). It is also important to inform<br>
physicians that immunocompromised patients, for instance those<br>
receiving TNF-inhibitors or being HIV positive, do often not respond<br>
to standard treatment.<br>
<br>
A country specific recent review of leishmaniasis was published by J<br>
Alvar and colleagues in 2012 (Alvar J, Vélez ID, Bern C, et al. WHO<br>
Leishmaniasis Control Team: Leishmaniasis worldwide and global<br>
estimates of its incidence. PLoS One. 2012; 7(5): e35671. doi:<br>
10.1371/journal.pone.0035671;<br>
<<a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035671" rel="noreferrer" target="_blank">http://journals.plos.org/plos<wbr>one/article?id=10.1371/journal<wbr>.pone.0035671</a>>).<br>
- Mod.EP<br>
<br>
A HealthMap/ProMED-mail map can be accessed at:<br>
<<a href="http://healthmap.org/promed/p/106" rel="noreferrer" target="_blank">http://healthmap.org/promed/p<wbr>/106</a>>.]<br>
<br>
[See Also:<br>
Leishmaniasis - Brazil (02): new sandfly vect susp, Psathyromyia<br>
elizabethdorvalae <a href="http://promedmail.org/post/20161101.4600154" rel="noreferrer" target="_blank">
http://promedmail.org/post/201<wbr>61101.4600154</a><br>
Leishmaniasis, visceral - Brazil: (MG) children<br>
<a href="http://promedmail.org/post/20161029.4593491" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>61029.4593491</a><br>
Leishmaniasis, visceral - Nepal: (MO)<br>
<a href="http://promedmail.org/post/20161002.4531103" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>61002.4531103</a><br>
Leishmaniasis, visceral - South Sudan: (UN)<br>
<a href="http://promedmail.org/post/20160910.4479134" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60910.4479134</a><br>
Leishmaniasis, cutaneous - Syria (03): (HL)<br>
<a href="http://promedmail.org/post/20160821.4430681" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60821.4430681</a><br>
Leishmaniasis, cutaneous - Pakistan (05): (TA)<br>
<a href="http://promedmail.org/post/20160717.4350532" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60717.4350532</a><br>
Leishmaniasis, cutaneous - Syria (02)<br>
<a href="http://promedmail.org/post/20160630.4319680" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60630.4319680</a><br>
Leishmaniasis, cutaneous - Syria: refugees<br>
<a href="http://promedmail.org/post/20160529.4252805" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60529.4252805</a><br>
Leishmaniasis, cutaneous - Palestinian Auth: (WE)<br>
<a href="http://promedmail.org/post/20160528.4250881" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60528.4250881</a><br>
Leishmaniasis, cutaneous - Pakistan (04): (NW) EpiCore responses<br>
<a href="http://promedmail.org/post/20160521.4236192" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60521.4236192</a><br>
Leishmaniasis, cutaneous - Pakistan (03): (NW)<br>
<a href="http://promedmail.org/post/20160518.4230112" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60518.4230112</a><br>
Leishmaniasis, cutaneous - Colombia: (NS) alert<br>
<a href="http://promedmail.org/post/20160429.4192208" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60429.4192208</a><br>
Leishmaniasis, cutaneous - Pakistan: (02): (NW)<br>
<a href="http://promedmail.org/post/20160418.4167556" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60418.4167556</a><br>
Leishmaniasis, cutaneous - Iraq: (DA) Yazidi refugees<br>
<a href="http://promedmail.org/post/20160415.4161067" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60415.4161067</a><br>
Leishmaniasis, cutaneous - Libya: (TR)<br>
<a href="http://promedmail.org/post/20160414.4160311" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60414.4160311</a><br>
Leishmaniasis - Colombia: (TO) RFI<br>
<a href="http://promedmail.org/post/20160403.4136205" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60403.4136205</a><br>
Leishmaniasis, canine - France<br>
<a href="http://promedmail.org/post/20160220.4033101" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60220.4033101</a><br>
Leishmaniasis, cutaneous - Pakistan: (TA)<br>
<a href="http://promedmail.org/post/20160217.4027519" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60217.4027519</a><br>
Leishmaniasis - Albania, Jordan, Pakistan: surveillance 2015<br>
<a href="http://promedmail.org/post/20160210.4009452" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60210.4009452</a><br>
Leishmaniasis - Uruguay: (SA) canine, alert<br>
<a href="http://promedmail.org/post/20160122.3952222" rel="noreferrer" target="_blank">http://promedmail.org/post/201<wbr>60122.3952222</a>]<br>
..............................<wbr>...................sb/ep/mj/sh<br>
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