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.