Leishmaniasis: A multifaceted approach to diagnosis, maladies, drug repurposing and way forward

Abstract

More than 20 species of the protozoan parasite Leishmania cause leishmaniasis, a disease spread by sand flies. The WHO lists leishmaniasis as one of the most ubiquitous neglected tropical illnesses. As per the reports, more than 1.3 million cases worldwide result in 20,000–30,000 fatalities every year. Although the global burden of disease is not rising, there remains a chance that it could spread. Leishmaniasis is predominantly detected in Brazil, Ethiopia, India, Kenya, Somalia, South Sudan, and Sudan, with transmission occurring through bites from infected phlebotomine sand flies to humans and other hosts. Pathogenesis of leishmaniasis based on the pathogen or host mechanism. The diagnosis of leishmaniasis is distinguished by clinical pleomorphism confirmation and also done by parasitological methods which are highly specific and sensitive. Despite the favoring of drugs such as Amphotericin B, sodium stibogluconate IV and meglumine IM (antimonial), miltefosine, paromomycin, and pentamidine, specific treatments, medications, and vaccination are still lacking for this neglected disease. Consequently, the drug repurposing-based approach has been adopted to fill this gap. The control measures vary from region to region. This review article describes the epidemiology, clinical aspects featuring the diagnostic and therapeutic techniques along with the benefits and challenges of repurposing drugs. Drugs of various categories have been repurposed to treat leishmaniasis, for instance, Clotrimazole, Nystatin (antifungal); Escitalopram, Imipramine (antidepressant); Paromomycin, Pentamidine (antibiotics); Sunitinib, Lapatinib (anticancer) and many more. The study focuses on the necessity of thorough validation, pharmacological constraints, and regulatory requirements by utilizing advances in computational biology and screening, which can be used as a promising treatment. Integrated treatment strategies for leishmaniasis co-infections and exploring drug repurposing methods for enhanced therapeutic outcomes. • Drug resistance mechanism in leishmania parasite. • Modern diagnostic techniques for leishmaniasis. • Drug repurposing to combat leishmaniasis. • Current clinical trials of vaccines and drugs. • In-silico screening and testing.