Neuroleishmaniasis: A Comprehensive Review of the Neurologic Manifestations of Leishmania spp. Infection

The clinical manifestation of leishmaniasis, caused by protozoan parasites of the Leishmania genus, ranges from cutaneous lesions to severe visceral disease. The present study is a comprehensive overview of the neurologic manifestations of Leishmania spp. infection, highlighting the epidemiology, clinical presentation, pathogenesis, diagnosis, and management. Also, epidemiological factors, including geographical distribution, vector species, and host susceptibility, influence the prevalence and distribution of neuroleishmaniasis. Clinical presentation of neuroleishmaniasis varies widely and may include meningoencephalitis, encephalopathy, myelitis, peripheral neuropathy, seizures, and cognitive impairment. The diversity of neurological manifestations reflects the complex interactions between the parasite, host immune response and neural tissues. Diagnostic challenges arise due to the nonspecific nature of symptoms, limited sensitivity of available tests, and difficulties in accessing CNS tissues for definitive diagnosis. Treatment of neuroleishmaniasis requires a multidisciplinary approach, with antiparasitic drugs such as liposomal amphotericin B and miltefosine serving as the mainstays of therapy. Adjunctive therapies, including corticosteroids and anticonvulsants, may manage neurological complications and alleviate symptoms. However, challenges such as drug resistance, limited CNS penetration, and systemic toxicity pose significant obstacles to treatment success. Prevention of neuroleishmaniasis involves vector control measures, reservoir management, health education, and community engagement. Integrated control strategies to reduce human-vector contact and interrupt disease transmission are essential for mitigating the burden of neuroleishmaniasis and improving patient outcomes.