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Clinical Microbiology Reviews, January 2006, p. 111-126, Vol. 19, No. 1
0893-8512/06/$08.00+0     doi:10.1128/CMR.19.1.111-126.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Drug Resistance in Leishmaniasis

Simon L. Croft,1* Shyam Sundar,2 and Alan H. Fairlamb3

Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom,1 Infectious Diseases Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India,2 Division of Biological Chemistry and Molecular Biology, Wellcome Trust Biocentre, School of Life Sciences, University of Dundee, Dundee DD1 5EH, Scotland, United Kingdom3

Leishmaniasis is a complex disease, with visceral and cutaneous manifestations, and is caused by over 15 different species of the protozoan parasite genus Leishmania. There are significant differences in the sensitivity of these species both to the standard drugs, for example, pentavalent antimonials and miltefosine, and those on clinical trial, for example, paromomycin. Over 60% of patients with visceral leishmaniasis in Bihar State, India, do not respond to treatment with pentavalent antimonials. This is now considered to be due to acquired resistance. Although this class of drugs has been used for over 60 years for leishmaniasis treatment, it is only in the past 2 years that the mechanisms of action and resistance have been identified, related to drug metabolism, thiol metabolism, and drug efflux. With the introduction of new therapies, including miltefosine in 2002 and paromomycin in 2005-2006, it is essential that there be a strategy to prevent the emergence of resistance to new drugs; combination therapy, monitoring of therapy, and improved diagnostics could play an essential role in this strategy.

* Corresponding author. Present address: Drugs for Neglected Diseases Initiative, 1 Place Saint-Gervais, CH-1201 Geneva, Switzerland. Phone: 0041 (0)22 906 9238. Fax: 0041 (0)22 906 9231. E-mail: scroft{at}dndi.org.

Clinical Microbiology Reviews, January 2006, p. 111-126, Vol. 19, No. 1
0893-8512/06/$08.00+0     doi:10.1128/CMR.19.1.111-126.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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