Öz
Visseral leishmaniasis (VL), Akdeniz bölgesinde hipoendemik olan ancak Bihar, Sudan ve Kuzeydoğu Brezilya gibi bölgelerde hiperendemik olan kronik bir parazitozdur. Leishmania donovani ve Leishmania infantum ana etiyolojik ajanlardır. Vektörler (flebotomin tatarcıkları) tarafından enfeksiyon bulaştırıldıktan sonra, VL’nin şiddeti hafif semptomatik bir hastalıktan hızla gelişen ciddi bir sendroma kadar değişebilir. Visseral leishmaniasis bağışıklığı baskılanmış yetişkinleri etkilediğinde, enfeksiyon sıklıkla pausisemptomatik seyreder veya atipik belirtiler ve düşük dereceli ateşle birlikte sinsi bir şekilde prezente olur. İnsan immün yetmezlik virüsü (HIV) enfeksiyonu olan hastalarda ve organ nakli alıcılarında, Güneybatı Avrupa’da ve birçok hiperendemik bölgede endişe verici bir risk faktörü olan VL ve HIV/VL koenfeksiyonu riskinde artış bildirilmektedir. Etkili tedaviler sınırlıdır ve bağışıklığı baskılanmış durumdaki hastaların prognozu tahmin edilemez. Diğer tedavilerle karşılaştırıldığında, lipozomal amfoterisin B (L-AmB) kullanımına dayalı tedavi, daha düşük yan etki insidansı ile ilişkilidir, ancak maliyeti düşük gelirli ülkelerde kullanımını engellemektedir. Antimonlar en uzun süre kullanılan ilaçlardır. Bununla birlikte, advers reaksiyonlar yaygındır ve bu ilaç sınıfına karşı direnç mekanizmaları güçlenmiştir. Mevcut tek oral ilaç olan Miltefosin, L. infantum enfeksiyonuna karşı belirsiz bir etkiye sahiptir. Paromomisinin etkinliği hakkındaki veriler de sınırlıdır. VL/HIV koenfeksiyonu olan hastalarda nüksler ve ilaçlara direnç gözlenir.
Anahtar Kelimeler: Visseral leishmaniasis, bağışıklığı baskılanmış hastalar, ilaçlar
Kaynakça
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