TREATMENT OF LEISHMANIASIS WITH LIPOSOMAL AMPHOTERICIN B: AN INTEGRATIVE REVIEW OF THE LITERATURE (Atena Editora)

Abstract

Introduction: Leishmaniasis are infectious-parasitic diseases, caused by parasites of the genus Leishmania and transmitted by hematophagous insects of the genus: Lutzomyia. The forms of the disease found are American Tegumentary Leishmaniasis (ATL) and Visceral Leishmaniasis (VL). ATL has a variable clinical presentation, including multiple or single skin ulcers, diffuse cutaneous leishmaniasis and mucosal lesions. VL can occur asymptomatically or present with classic symptoms such as fever, hepatosplenomegaly, weight loss, cough, diarrhea, pain and abdominal distension. It is estimated that around 300,000 new cases result in 30,000 deaths/year worldwide. Drug treatment is the main current control measure, but has limitations due to toxicity and high cost. Liposomal amphotericin B stands out with its innovative performance. Objective: To evaluate the advantages of treating Leishmaniasis with liposomal amphotericin B and its therapeutic regimen. Method: Literature review, with consultation of the UpToDate database using the descriptors Leishmaniasis and Amphotericin B, according to the Health Science Descriptors (DeCS/MeSH) the following search terms were used: Visceral Leishmaniasis, Treatment, Amphotericin B., Liposomes and Liposomes of prolonged circulation. Results: Liposomal amphotericin B consists of incorporating the drug into liposomes that are phagocytosed by macrophages in which the parasite is concentrated. The formulation improved stability in blood, macrophages and tissues, allowing sustained drug levels in tissue penetration. The presence of cholesterol mimics its action on mammalian membranes, providing greater specificity without causing adverse effects such as nephrotoxicity, hypokalemia, anemia, peripheral venous phlebitis and fever with chills related to the infusion, guaranteeing a great therapeutic advantage. In the cutaneous form, management is based on severity, in uncomplicated or complicated infections. The objective is clinical cure, since most infections resolve without treatment and not all treated patients eliminate the parasite. The mucous form is difficult to obtain a cure; therefore, the aim is to reduce morbidity and mortality. There are few randomized clinical trials, however it was observed that the toxicity of liposomal amphotericin B is lower than that of amphotericin deoxycholate, although data are limited in relation to the ideal dose and duration of therapy, in addition to cost limitations. In the visceral form, treatment is essential and consists of liposomal amphotericin B as it is more effective and safer. The most commonly used therapeutic regimen consists of the following doses according to specific situations.