Visceral leishmaniasis: a forgotten epidemic

Area of Science:

• * Infectious Diseases
• * Parasitology
• * Public Health

Background:

• * Visceral leishmaniasis (VL), also known as kala-azar, is a significant public health concern, primarily endemic in Asia and Africa.
• * It commonly affects young children and is caused by *Leishmania donovani* or *Leishmania infantum*, transmitted by Phlebotomine sand flies.
• * Risk factors include younger age, malnutrition, and immunosuppression (e.g., HIV infection).

Purpose of the Study:

• * To summarize the epidemiology, clinical presentation, diagnosis, treatment, and control strategies for visceral leishmaniasis.
• * To highlight challenges in managing VL, particularly in HIV co-infected individuals.

Main Methods:

• * Review of diagnostic methods including direct parasite demonstration (lymph node, bone marrow, spleen aspirates), serological tests (rK39 strip test), and qPCR.
• * Discussion of current treatment modalities, including AmBisome monotherapy and drug combinations.
• * Overview of control strategies: case finding, diagnostics, reservoir control, and vector protection.

Main Results:

• * VL presents with fever, hepatosplenomegaly, weight loss, and pancytopenia, though many infections are asymptomatic.
• * Diagnostic sensitivity varies among methods; qPCR aids in detecting low parasite loads and monitoring treatment.
• * HIV co-infected patients present treatment difficulties and higher relapse rates.

Conclusions:

• * Effective VL control requires integrated approaches encompassing diagnosis, treatment, and prevention.
• * Further research is needed for improved treatment strategies, especially for vulnerable populations and those with co-infections.
• * Development of a human vaccine remains a critical unmet need.