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Leishmaniasis is caused by a protozoa parasite from over 20 Leishmania species. Over 90 sandfly species are known to transmit Leishmania parasites. There are 3 main forms of the disease:

• Visceral leishmaniasis (VL), also known as kala-azar is fatal if left untreated in over 95% of cases. It is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia. Most cases occur in Brazil, East Africa and in India. An estimated 50 000 to 90 000 new cases of VL occur worldwide annually, with only between 25 to 45% reported to WHO. It remains one of the top parasitic diseases with outbreak and mortality potential. In 2019, more than 90% of new cases reported to WHO occurred in 10 countries: Brazil, Ethiopia, Eritrea, India, Iraq, Kenya, Nepal, Somalia, South Sudan and Sudan.

Transmission

• Leishmania parasites are transmitted through the bites of infected female phlebotomine sandflies, which feed on blood to produce eggs. The epidemiology of leishmaniasis depends on the characteristics of the parasite and sandfly species, the local ecological characteristics of the transmission sites, current and past exposure of the human population to the parasite, and human behaviour. Some 70 animal species, including humans, have been found as natural reservoir hosts of Leishmania parasites

Diagnosis and treatment

In visceral leishmaniasis, diagnosis is made by combining clinical signs with parasitological, or serological tests (such as rapid diagnostic tests). In cutaneous and mucocutaneous leishmaniasis serological tests have limited value and clinical manifestation with parasitological tests confirms the diagnosis.

The treatment of leishmaniasis depends on several factors including type of disease, concomitant pathologies, parasite species and geographic location. Leishmaniasis is a treatable and curable disease, which requires an immunocompetent system because medicines will not get rid of the parasite from the body, thus the risk of relapse if immunosuppression occurs. All patients diagnosed as with visceral leishmaniasis require prompt and complete treatment. Detailed information on treatment of the various forms of the disease by geographic location is available in the WHO technical report series 949, "Control of leishmaniasis".

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