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Journal of Tropical Medicine
Volume 2013, Article ID 319234, 5 pages
http://dx.doi.org/10.1155/2013/319234
Review Article

Challenges in the Therapy of Visceral Leishmaniasis in Brazil: A Public Health Perspective

1Hospital Estadual Bauru, Secretaria de Estado da Saúde de São Paulo, 17033-360 Bauru, SP, Brazil
2Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), 18618-970 Botucatu, SP, Brazil

Received 27 May 2013; Revised 4 November 2013; Accepted 4 November 2013

Academic Editor: Shyam Sundar

Copyright © 2013 Edson Carvalho de Melo and Carlos Magno Castelo Branco Fortaleza. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Over 3,000 yearly cases of Visceral Leishmaniasis (VL) are reported in Brazil. Brazilian Public Health System provides universal free access to antileishmania therapeutic options: Meglumine Antimoniate, Amphotericin B deoxycholate, and Liposomal Amphotericin B. Even though Amphotericin formulations have been advised for severe disease, this recommendation is mostly based on the opinion of experts and on analogy with studies conducted in other countries. Presently, there are two ongoing multicenter clinical trials comparing the efficacy and safety of the available therapeutic options. Some other issues require further clarification, such as severity markers and the approach to VL/AIDS coinfection. Brazil is facing the challenge of providing access to diagnosis and adequate treatment, in order to avoid VL-related deaths.