Treatment, prevention and control of leishmaniasis in Sri Lanka

Treatment options for leishmaniasis consist of no treatment option, medical treatment and surgical treatment. Always treat visceral, mucocutaneous, severe form of cutaneous leishmaniasis and new world cutaneous leishmaniasis with a tendency to develop into mucocutaneous form. Old world cutaneous leishmaniasis tends to resolve spontaneously and need no treatment but should receive treatment if the lesions are disfiguring, painful, infected, over joints or slow to heal.

Sodium stibogluconate is the gold standard therapy for leishmaniasis. For localized cutaneous leishmaniasis topical therapy (intralesional and local application) is recommended as the first line therapy. Intralesional sodium stibogluconate is the widely accepted intralesional treatment in Sri Lanka. Intralesional hypertonic sodium chloride solution, zinc sulphate or metronidazole also proven to be effective. Cryotherapy is used to treat few localized lesions. For complicated cutaneous leishmaniasis and for diffuse cutaneous leishmaniasis intramuscular sodium stibogluconate is being used. Mucocutaneous leishmaniasis is treated with sodium stibogluconate (IM) or amphotericin B. For visceral leishmaniasis sodium stibogluconate (IM/IV) is recommended. In addition to antileishmanial therapy intercurrent infections require antibiotics. Reticuloendothelial failure with visceral leishmaniasis need appropriate supportive measures. Severe mucocutaneous leishmaniasis may require orofacial reconstructive surgery.

Prevention of bites is important to reduce the prevalence of the disease in the country.