Visceral leishmaniasis patients waiting to see a healthcare worker at the Kala-Azar Medical Research Centre (KAMRC), Muzaffarpur, Bihar, India.
› Leishmaniasis affects the poorest of the poor and has
strong links with malnutrition, low-quality housing, and lack of resources. Some 350 million people around the world are at risk of developing leishmaniasis in one of its many forms. There are more than 20 species of Leishmania parasite, transmitted to humans by approximately 30 species of phlebotomine sand flies found throughout the tropics and subtropics, as well as in temperate zones. One of the two most common forms of disease, visceral leishmaniasis (VL) or kala-azar, is fatal without treatment. There are 200,000-400,000 new cases per year, albeit with a large reduction recently in South Asia. The WHO’s roadmap for elimination - published in 2012 and supported by the London Declaration the same year - targets elimination of kala-azar as a public health problem by the end of 2020 in South Asia. Surprisingly, the response of visceral leishmaniasis to treatment is not homogenous across continent s , nor even within the same region, and different drugs and/ or regimens are needed, particularly in eastern Africa. Intermediate results from an implementation trial which was underway in India, carried out by DNDi and partners, led the government to change its treatment guidelines in 2014, abandoning miltefosine monotherapy in favour of single-dose AmBisome® as first-line and a combination of paromomycin/miltefosine as second-line treatment. These changes were subsequently also taken up by the governments of Bangladesh and Nepal. Similarly in Latin America, the interim results of an implementation trial carried out by DNDi with partners in Brazil led to Ambisome® being included as second-line treatment after Glucantime®, with the final results now suggesting it would be more suitable as first-line treatment. In addition, Ambisome® alone or in combination with miltefosine is being evaluated in Ethiopia for treating VL patients who are co-infected with HIV. Post kala-azar dermal leishmaniasis (PKDL) is a complication of VL. Treating PKDL patients, which may
Multiple approaches needed to address a complex family of diseases