Overview of Leishmaniasis with Special Emphasis on Kala-azar in South Asia (original) (raw)

2017, Neglected tropical diseases

Abbreviations AVL Anthroponotic visceral leishmaniasis CL Cutaneous leishmaniasis DALY Disability-adjusted life year IRS Insecticide residue spread MCL Mucocutaneous leishmaniasis NTD Neglected tropical diseases PKDL Post-kala-azar dermal leishmaniasis PV Parasite-containing vacuole rK39 Recombinant kinesin 39 amino acid repeats rKE16 Recombinant kinesin antigen from L. donovani VL Visceral leishmaniasis ZCL Zoonotic cutaneous leishmaniasis 1 Global Overview of Leishmaniasis 1.1 Disease Types Leishmaniasis is a complex disease caused by Leishmania infection, producing variable clinical symptoms, e.g., cutaneous, mucocutaneous, and visceral leishmaniases [1-3]. Cutaneous leishmaniasis (CL) caused, for example, by Leishmania major/L. tropica is marked by the appearance of skin lesion in various forms, which are often innocuous and self-healing, while mucocutaneous leishmaniasis (MCL) caused, for example, by L. braziliensis is a protracted disease, resulting sometimes in facial disfigurement of the ear, mouth, and nose. Neither CL nor MCL is lifethreatening per se. Only in non-healing case has death of these patients been reported due to secondary infections or other causes, e.g., suicide as a result of unbearable psychological stress. Visceral leishmaniasis (VL) caused by L. donovani/L. infantum is far more severe. It is often fatal, if untreated, resulting from systemic and progressive infection of macrophages by Leishmania in the reticuloendothelial systems or lymphoid organs, chiefly the spleen, liver, and bone marrow. Disorders of hematological and hepatosplenic functions are thus the clinical manifestations of VL, including hepatosplenomegaly, fever, anemia, leucopenia, hypergammaglobulinemia, and cachexia. The development of all leishmaniases follows a chronic course lasting for months and sometimes years. A vibrant and active biomedical research community has long existed in India, under the aegis of both national and international organizations, for basic, clinical, and other researches of kala-azar. There are internationally sought-after kala-azar clinics in the well-established endemic sites, drug/vaccine production facilities, and many kala-azar research laboratories. Nowhere else in the world can one find another country, except perhaps Brazil, to match India in the scale of dedication, devotion, and contribution to kala-azar research. Given below are examples of some Indian institutions and recent kala-azar research to illustrate the points. 4.1 Indian Institutions with Kala-azar Research Components Some Indian government agencies, which provide administrative and financial support: