Treatment failure in leishmaniasis: drug-resistance or another (epi-) phenotype?

摘要: Two major leishmaniasis treatments have shown a significant decrease in effectiveness the last few decades, mostly Indian subcontinent but also other endemic areas. Drug resistance of Leishmania correlated only partially to treatment failure (TF) pentavalent antimonials, and has so far proved not be important for increased miltefosine relapse rates observed subcontinent. While patient- or drug-related factors could played role, recent studies identified several parasite features such as infectivity host manipulation skills that might contribute TF. This perspective aims discuss how different parasitic than drug can TF this may vary between epidemiological contexts.