Visceral leishmaniasis

About: Visceral leishmaniasis is a research topic. Over the lifetime, 7486 publications have been published within this topic receiving 184865 citations. The topic is also known as: Kala-Azar & viscus leishmaniasis.

Asymptomatic human carriers of Leishmania infantum: possible reservoirs for Mediterranean visceral leishmaniasis in southern Iran

Abstract: Over the last decade, the incidence of visceral leishmaniasis (VL) has increased in many districts of the province of Fars, in southern Iran. Recent epidemiological reports indicate that asymptomatic human infections with Leishmania infantum (the causative agent of VL throughout the Mediterranean basin) occur more frequently in Iran than was previously believed. Between 2004 and 2006, blood samples were collected from 802 apparently healthy subjects from communities, in the north-west and south-east of Fars province, where VL cases had been recorded. Each of these samples was tested for anti-Leishmania antibodies, in direct agglutination tests (DAT), and for L. infantum kinetoplast DNA, in PCR-based assays. Of the 426 subjects from north-western Fars, eight (1.9%) were found seropositive and 68 (16.0%) PCR-positive. The corresponding values for the 376 subjects from south-eastern Fars were lower, with five (1.3%) seropositive and 32 (8.5%) PCR-positive. Of the 100 PCR-positive subjects, 18 (18.0%) each lived in a household in which there had been a case of VL, and six (6.0%) had had VL themselves (in each case, more than a year before the blood sampling for the present study). Although 21 of the PCR-positives have now been followed-up for at least 18 months, none has developed symptomatic VL. Since positivity in the PCR-based assay probably indicated the presence of L. infantum amastigotes in the peripheral blood of 12.5% of the subjects, it is clear that asymptomatic human carriers of L. infantum are quite common in the study areas and probably act as reservoirs in the transmission of the parasite, to humans and to dogs, by sandflies.

Geographic spread of visceral leishmaniasis in Brazil.

Abstract: Cad. Saúde Pública, Rio de Janeiro, 26(4):644-645, abr, 2010 Visceral leishmaniasis (VL) affects 65 countries, with an estimated incidence of 500 thousand new cases and 59 thousand deaths per year. In Brazil, the disease is caused by the protozoan Leishmania infantum chagasi, transmitted by sandflies from genus Lutzomyia, with dogs as the principal source of infection in urban areas. VL is a serious disease with few treatment options, and even with adequate treatment the case fatality rate is some 5%. Historically, VL has been considered a rural endemic, but since the 1980s the disease has undergone gradual urbanization. The first major urban epidemic in the country was in Teresina, Piaui State. Epidemics occurred later in Natal (Rio Grande do Norte) and São Luís (Maranhão), and the disease subsequently spread to other regions of the country. Autochthonous cases were recently described for the first time in the southernmost State of Rio Grande do Sul. The epidemiological panorama leaves no doubt as to the severity of the situation and the unchecked geographic spread of VL. From 1980 to 2008, more than 70 thousand cases of VL were reported in Brazil, with 3,800 deaths. The mean number of cases reported per year increased from 1,601 (1985-1989) to 3,630 (2000-2004), leveling off since then. In the 1990s, only 10% of cases occurred outside the Northeast Region, but in 2007 the proportion reached 50% of cases. From 2006 to 2008, autochthonous transmission of VL was reported in more than 1,200 municipalities (counties) in 21 States. VL is a neglected disease that affects neglected populations. Poverty, migration, unplanned urban settlement, environmental destruction, precarious sanitation and housing, and malnutrition are some of its numerous determinants. The World Health Organization recognizes the lack of sufficient means for its elimination, despite initiatives on the Indian subcontinent, where the disease is transmitted from person to person by vector bites. In this case, treatment of cases may help decrease transmission. However, in Brazil, where the disease is zoonotic, treatment of human cases plays an essentially curative role. The National Program for the Control of Visceral Leishmaniasis bases its strategy on the detection and treatment of human cases, control of domestic reservoirs, and vector control. Still, after years of investment, these measures have proven insufficient to prevent spread of the disease. The introduction of VL in Brazilian cities represents a different epidemiological reality from the historical situation and requires new strategies by VL surveillance and control systems. Visceral leishmaniasis raises many challenges, but the emphasis should be on scientific and technological development and health innovation. More research is needed for the development of new drugs, treatment regimens, and clinical management protocols. Studies on the effectiveness of control measures should be backed by solid methodologies; it is necessary to invest in integrated tactics for structured intervention according to the different transmission scenarios, preferably targeting the areas at highest risk. The production and validation of new diagnostic tests should be highlighted. Studies for effective vaccines to protect individuals and decrease transmission should be prioritized. Research should also be encouraged to solve operational barriers to the implementation of preventive measures. There is still a huge lack of knowledge on VL. However, besides scientific production itself, a broad social commitment is needed to prevent VL from taking a definitive foothold as one more serious health problem in Brazil’s daily urban reality. Geographic spread of visceral leishmaniasis in Brazil EDITORIAL

Unusual cutaneous lesions in two patients with visceral leishmaniasis and HIV infection

Abstract: Two HIV infected patients with visceral leishmaniasis and unusual cutaneous lesions are described. The first patient developed linear brown macules containing Leishmania parasites on the fingers and palms of the hands. This patient never received highly active antiretroviral treatment and the visceral leishmaniasis could not be cured even with liposomal amphotericin. In the second patient, Leishmania parasites were present in a skin biopsy of a fibrous histiocytoma. After completing visceral leishmaniasis treatment, a discrete elevation of one of his tattoos was seen. A biopsy specimen of this tattoo revealed Leishmania amastigotes. In this patient the visceral leishmaniasis was finally cured with meglumine antimoniate, followed by pentacarinat isothianate as maintenance therapy in conjunction with highly active antiretroviral treatment.