Leishmaniasis: Types, Transmission, and Global Impact

Key Facts:

  1. Leishmaniasis Types:
    • Visceral Leishmaniasis (VL): Also known as kala-azar, it’s fatal if untreated in over 95% of cases. Common in Brazil, East Africa, and India. Annual new cases: 50,000 to 90,000.
    • Cutaneous Leishmaniasis (CL): Most common, causes skin lesions, mainly ulcers. 95% of cases in the Americas, Mediterranean, Middle East, and Central Asia. Estimated annual new cases: 600,000 to 1 million.
    • Mucocutaneous Leishmaniasis: Affects mouth, nose, and throat. Over 90% of cases in Bolivia, Brazil, Ethiopia, and Peru.
  2. Transmission: Protozoan parasites transmitted by infected female phlebotomine sandflies. Over 90 sandfly species can transmit Leishmania parasites. Humans and 70 other animal species can be the parasite source.
  3. Global Impact:
    • Estimated 700,000 to 1 million new cases annually.
    • Visceral leishmaniasis has outbreak and mortality potential.
    • Risk factors include poverty, malnutrition, population mobility, and environmental changes.
    • Leishmaniasis-HIV coinfection reported in 45 countries.

Regional Specificities:

  1. WHO African Region:
    • Cutaneous Leishmaniasis highly endemic in Algeria.
    • East Africa faces frequent outbreaks of visceral leishmaniasis.
  2. WHO Region of the Americas:
    • Brazil is the main country endemic for visceral leishmaniasis.
    • Complex epidemiology with multiple sandfly types and Leishmania species.
  3. WHO Eastern Mediterranean Region:
    • Accounts for 80% of cutaneous leishmaniasis cases globally.
    • Visceral leishmaniasis highly endemic in Iraq, Somalia, Sudan, and Yemen.
  4. WHO European Region:
    • Both cutaneous and visceral leishmaniasis are endemic.
    • Common imported cases from Africa and the Americas.
  5. WHO South-East Asia Region:
    • Visceral leishmaniasis is the main form of the disease.

Other Aspects:

  1. Post-kala-azar Dermal Leishmaniasis (PKDL):
    • Sequel of visceral leishmaniasis.
    • Appears as rash on face, upper arms, and trunk.
    • Reported in Sudan, the Indian subcontinent, and Brazil.
  2. Leishmania-HIV Coinfection:
    • High chances of developing the full-blown disease.
    • Reported in 45 countries, with high rates in Brazil, Ethiopia, and Bihar (India).
    • Antiretroviral treatment reduces disease development and increases survival.

Major Risk Factors:

  1. Socioeconomic Conditions:
    • Poverty, poor housing, and sanitary conditions increase risk.
    • Sandflies are attracted to crowded housing.
  2. Malnutrition:
    • Diets lacking essential nutrients increase the risk of progression to the disease.
  3. Population Mobility:
    • Epidemics occur when non-immune people move to high-transmission areas.
  4. Environmental and Climate Changes:
    • Urbanization, deforestation, and climate change affect sandfly populations and disease spread.

Diagnosis and Treatment of Leishmaniasis

  • Diagnosis based on clinical signs and parasitological or serological tests.
  • Treatable and curable, but immunocompetence is crucial.
  • WHO provides guidelines for diagnosis and treatment.

Leishmaniasis Prevention and Control:

  • Early diagnosis and effective treatment are crucial.
  • Vector control, disease surveillance, and controlling animal reservoir hosts are key.
  • Prevention involves social mobilization, education, and partnership building.

WHO Response:

  • WHO supports national programs, monitors trends, develops policies, and promotes research.
  • Emphasis on early diagnosis, effective treatment, vector control, and social mobilization.
  • Special initiatives for leishmaniasis-HIV coinfection and elimination in the South-East Asia Region.

Understanding and addressing leishmaniasis requires a multifaceted approach involving medical, environmental, and socioeconomic strategies.

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