Leishmaniasis revisited: Current aspects on epidemiology, diagnosis and treatment

Abstract

Leishmaniasis is a vector-borne disease caused by protozoan parasites of the genus Leishmania. It is transmitted by phlebotomine female sand flies of the genera Phlebotomus and Lutzomyia in the old and new world, respectively. More than 20 well-recognized Leishmania species are known to infect humans and cause visceral (VL), cutaneous (CL) and mucocutaneous (ML) forms of the disease. Approximately 350 million people are at risk of contracting the disease and an estimated 1.6 million new cases occur annually. The disease mainly affects poor people in Africa, Asia and Latin America, and is associated with malnutrition, population migration, poor residency conditions, frail immune system and lack of resources. Previously, diagnosis of leishmaniasis relied mainly on invasive techniques of detecting parasites in splenic and bone marrow aspirates. Nevertheless, serological tests using the recombinant kinesin antigen (rK39) and molecular methods (polymerase chain reaction) are considered the best options for diagnosis today, despite problems related to varying sensitivities and specificities and field adaptability. Therapy of leishmaniasis ranges from local treatment of cutaneous lesions to systemic often toxic, therapy for disseminated CL, ML and VL. Agents with efficacy against leishmaniasis include amphotericin B, pentavalent antimonial drugs, paromomycin and miltefosine. No single therapy of VL currently offers satisfactory efficacy along with safety. This article provides a brief and updated systematic review on the epidemiology, diagnosis and treatment of this neglected disease.

Epidemiological, Biological and Clinical Aspects of Leishmaniasis with Special Emphasis on Busi Yasi in Suriname

“…Leishmaniasis in humans can be caused by about twenty-one of the thirty Leishmania parasite species known to infect mammals [1,2]. Among these are the species within the L. donovani complex; those within the L. mexicana complex; L. (L.) tropica; L. (L.) major; L. (L) aethiopica; and the members of the Viannia subgenus [5,7].…”

“…More exact species identification requires very sensitive methods which are based on isoenzyme analysis, molecular assays, and the use of monoclonal antibodies [1,6]. However, all Leishmania species are unicellular eukaryotes with a well-defined nucleus and other cell organelles including a characteristic kinetoplast and flagella ( Figure 3) [22,23].…”

“…Leishmaniasis is transmitted by the bite of infected female phlebotomine sandflies. The sandflies inject the infective stage (i.e., promastigotes) from their proboscis during blood meals (1). Promastigotes that reach the puncture wound are phagocytized by macrophages (2) and other types of mononuclear phagocytic cells.…”

“…Leishmaniasis is a complex of parasitic diseases caused by kinetoplastid flagellates of the genus Leishmania (Trypanosomatidae) [1,2] (Figure 1). These obligate intracellular protozoa are transmitted via infected female sand flies which are about one-third to half the size of a mosquito ( Figure 2).…”

Manejo integrado de los riesgos ambientales y el control de vectores: una nueva propuesta para la prevención sostenible y el control oportuno de las enfermedades transmitidas por vectores

“…Aproximadamente, 350 millones de personas se encuentran en riesgo por leishmaniasis, y anualmente ocurren entre 700.000 y un millón de casos nuevos de esta enfermedad, con 20.000 a 30.000 muertes, principalmente debidas a la forma visceral de la enfermedad (4,5).…”