Systematic Review of Treatment Failure and Clinical Relapses in Leishmaniasis from a Multifactorial Perspective: Clinical Aspects, Factors Associated with the Parasite and Host

Autor: Gustavo de Almeida Santos, Juliana Mendes Sousa, Antônio Henrique Braga Martins de Aguiar, Karina Cristina Silva Torres, Ana Jessica Sousa Coelho, André Leite Ferreira, Mayara Ingrid Sousa Lima
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Tropical Medicine and Infectious Disease, Vol 8, Iss 9, p 430 (2023)
Druh dokumentu: article
ISSN: 2414-6366
DOI: 10.3390/tropicalmed8090430
Popis: Leishmaniasis is a disease caused by protozoa of the genus Leishmania. Treatment options are limited, and there are frequent cases of treatment failure and clinical relapse. To understand these phenomena better, a systematic review was conducted, considering studies published between 1990 and 2021 in Portuguese, English, and Spanish. The review included 64 articles divided into three categories. Case reports (26 articles) focused on treatment failure and clinical relapse in cutaneous leishmaniasis patients (47.6%), primarily affecting males (74%) and children (67%), regardless of the clinical manifestation. Experimental studies on the parasite (19 articles), particularly with L. major (25%), indicated that alterations in DNA and genic expression (44.82%) played a significant role in treatment failure and clinical relapse. Population data on the human host (19 articles) identified immunological characteristics as the most associated factor (36%) with treatment failure and clinical relapse. Each clinical manifestation of the disease presented specificities in these phenomena, suggesting a multifactorial nature. Additionally, the parasites were found to adapt to the drugs used in treatment. In summary, the systematic review revealed that treatment failure and clinical relapse in leishmaniasis are complex processes influenced by various factors, including host immunology and parasite adaptation.
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