Philippe Desjeux

Visceral leishmaniasis: current status of control, diagnosis, and treatment, and a proposed research and development agenda

Visceral leishmaniasis is common in less developed countries, with an estimated 500000 new cases each year. Because of the diversity of epidemiological situations, no single diagnosis, treatment, or control will be suitable for all. Control measures through case finding, treatment, and vector control are seldom used, even where they could be useful. There is a place for a vaccine, and new imaginative approaches are needed. HIV co-infection is changing the epidemiology and presents problems for diagnosis and case management. Field diagnosis is difficult; simpler, less invasive tests are needed. Current treatments require long courses and parenteral administration, and most are expensive. Resistance is making the mainstay of treatment, agents based on pentavalent antimony, useless in northeastern India, where disease incidence is highest. Second-line drugs (pentamidine and amphotericin B) are limited by toxicity and availability, and newer formulations of amphotericin B are not affordable. The first effective oral drug, miltefosine, has been licensed in India, but the development of other drugs in clinical phases (paromomycin and sitamaquine) is slow. No novel compound is in the pipeline. Drug combinations must be developed to prevent drug resistance. Despite these urgent needs, research and development has been neglected, because a disease that mainly affects the poor ranks as a low priority in the private sector, and the public sector currently struggles to undertake the development of drugs and diagnostics in the absence of adequate funds and infrastructure. This article reviews the current situation and perspectives for diagnosis, treatment, and control of visceral leishmaniasis, and lists some priorities for research and development.

Implementation research to support the initiative on the elimination of kala azar from Bangladesh, India and Nepal – the challenges for diagnosis and treatment

1 Institute of Medical Sciences, Banaras Hindu University, Varanasi, India 2 Parasitology Laboratory, ICDDR, Dhaka, Bangladesh 3 Koirala Institute of Health Sciences, Dharan, Nepal 4 Additional Director General, Indian Council of Medical Research, New Delhi, India 5 WHO/TDR, Geneva, Switzerland 6 Institute of Tropical Medicine, Antwerp, Belgium 7 Institute for OneWorld Health, Divonne, France 8 Deutsche Gesellschaft fuer Technische Zusammenarbeit, GTZ, Eschborn, Germany 9 Institute of Tropical Medicine, Charite Medical School, Berlin, Germany

The economic impact of visceral leishmaniasis on rural households in one endemic district of Bihar, India

Objective To estimate the economic burden of visceral leishmaniasis (VL) on the rural population of one VL endemic district of Bihar, the state with 85% of India’s cases.

Annual incidence of visceral leishmaniasis in an endemic area of Bihar, India

The study presents the findings of a population‐based survey of the annual incidence of visceral leishmaniasis (VL) in the rural areas of one VL‐endemic district in Bihar, India. Stratified multi‐stage sampling was applied in the selection of blocks, villages, hamlets, and households. We screened 15 178 households (91 000 individuals) in 80 villages in 7 of 27 administrative blocks of the district, East Champaran. We identified 227 VL cases that occurred in the past 12 months: 149 treated individuals who survived, 14 who died from VL, and 64 active cases. The high‐incidence stratum had an estimated incidence of 35.6 cases per 10 000 persons per year (90% CI: 27.7–45.7). The annual incidence rate in the medium stratum areas was 16.8 cases per 10 000 (90% CI: 9.3–30.6). The combined annual incidence rate for the high and medium areas combined was 21.9 cases per 10 000 per year, (90% CI: 14.0–34.2). The Government of India’s VL elimination goal is to reduce the VL incidence to one case per 10 000 at the sub‐district level; thus, a 35‐fold reduction will be required in those areas with the highest VL incidence.

Post-kala-azar Dermal Leishmaniasis: Facing the Challenge of Eliminating Kala-Azar from South Asia

Post-kala-azar dermal leishmaniasis (PKDL) is a cutaneous complication of visceral leishmaniasis (VL) which usually appears after treatment of a VL episode. The incidence of PKDL varies across countries and no up-to-date global estimate is available. Parasitological diagnostic tests show either low sensitivity or are difficult to decentralize in the field (e.g., polymerase chain reaction). Available treatments are long, costly, and frequently toxic. It is believed that PKDL has a multi-factorial and complex origin. It is widely accepted that persons with PKDL harbor Leishmania parasites in the skin and, therefore, act as reservoirs of infection in VL transmission, especially during interepidemic periods. PKDL poses a serious threat to the success of the VL elimination program in South Asia, and requires an immediate and focused strategy from the health authorities in charge of the national programs in India, Nepal, and Bangladesh. Control and research efforts are urgently needed to improve PKDL surveillance and case management in order to reduce delays in diagnosis and treatment and, hence, reduce morbidity and the risk of transmission.

The economic impact of visceral leishmaniasis on rural households in one endemic district of Bihar, India: Economic impact of VL in Bihar

Objective To estimate the economic burden of visceral leishmaniasis (VL) on the rural population of one VL endemic district of Bihar, the state with 85% of India’s cases.

Visceral leishmaniasis supplement: the economic impact of visceral leishmaniasis on rural households in one endemic district of Bihar, India

Objective To estimate the economic burden of visceral leishmaniasis (VL) on the rural population of one VL endemic district of Bihar, the state with 85% of India’s cases.