Leishmaniases are neglected tropical diseases. The causative agents,
Leishmania
spp., are transmitted by the blood‐sucking female sand flies. The diseases are largely a zoonosis of canines, rodents and edentates. Humans are accidental dead‐end hosts, except in some places where human–human transmission is indicated by the absence of animal reservoirs. The diseases are present in >100 countries, mainly in tropical and subtropical areas, putting one billion world population at risk with an annual caseload of ∼one million and death in the tens of thousands. Leishmaniases are marked by a spectrum of clinical manifestations, ranging from self‐healing cutaneous lesions to facial mucocutaneous disfiguration to visceralisation with fatal consequence. Clinical managements of visceral leishmaniases rely on several toxic drugs with decreasing efficacy due to the development of drug resistance. Intraphagolysosomal parasitism of macrophages by these parasites is a key feature for considering molecular mechanisms of their virulence relevant to developing effective drugs and vaccines needed.
Key Concepts
The trypanosomatid protozoa in the genus of
Leishmania
cause leishmaniases.
The diseases are neglected, but very widespread mainly in tropical and subtropical countries.
The parasites live briefly in blood‐sucking sand flies and develop into infective promastigotes in the gut lumen.
Infected sand flies transmit the parasites among animals, e.g. canines, rodents and edentates.
Humans acquire leishmaniases from sand fly bites as a zoonosis with infected wild and domestic animals as the reservoirs.
Human leishmaniasis is referred to as anthroponotic where reservoir animals have not been identified.
The parasites live in the acidic endosomes/lysosomes of macrophages as amastigotes in the mammalian hosts.
There are cutaneous, mucocutaneous and visceral leishmaniases.
The spectrum of clinical manifestations results from immunopathology of different host‐parasite interactions.
Life‐long immunity to leishmaniases often develops in patients cured of these diseases.
Chemotherapy of leishmaniases relies on toxic drugs and loses its effectiveness to drug‐resistance.
Visceral leishmaniasis has been brought under control in some endemic countries.
Control programs include diagnosis of patients for treatments, surveillance of reservoirs and vectors for elimination.
Lack of incentives for drug and vaccine development accounts for the persistence of leishmaniases.