Visceral leishmaniasis (kala-azar) is a severe, often fatal form of leishmaniasis caused by protozoan parasites of the genus Leishmania, with Leishmania donovani responsible on the Indian sub-continent [1][2]. It is a sandfly-transmitted zoonotic infection whose primary animal reservoir includes dogs [2].
Aperçu de la maladie
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Kala-azar, or visceral leishmaniasis, is a severe and frequently fatal parasitic disease caused by Leishmania species and transmitted by sandflies [1][2]. In the Indian sub-continent it is principally due to Leishmania donovani, while a late cutaneous complication known as post-kala-azar dermal leishmaniasis can follow in a substantial proportion of cases and sustains transmission [1][3]. Recurrence in endemic tropical regions such as India is linked to asymptomatic infection, PKDL, and HIV co-infection [4].
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The disease commonly presents with fever, hepatosplenomegaly, and pancytopenia [2]. A subsequent skin manifestation, post-kala-azar dermal leishmaniasis, develops in 10–60% of cases as an often asymptomatic rash beginning on the face and showing macules, papules, or nodules [3]. Field diagnosis of PKDL is difficult and usually clinical, with parasitological confirmation preferred before treatment consideration [3].
Visceral leishmaniasis occurs worldwide as a zoonotic infection, with low prevalence reported in Germany where affected persons are mainly migrants and travelers returning from Mediterranean countries [2]. In India and other tropical endemic areas, recurrence is driven by asymptomatic VL, PKDL, and HIV co-infection [4]. Elimination programs in the Indian sub-continent target fewer than one case per 10,000 population at district or sub-district level [1].
Post Kala-azar Dermal Leishmaniasis (PKDL) serves as a significant yet neglected reservoir of infection and plays a crucial role in the transmission of the disease, posing a serious threat to the visceral leishmaniasis elimination program in the Indian sub-continent [1].
Achieving elimination in the Indian sub-continent requires prioritising eradication of PKDL alongside visceral leishmaniasis, because PKDL sustains transmission and threatens control goals [1]. Optimising surveillance, control measures, and intervention strategies is needed to reduce the burden and support successful elimination [1].
- 1 Kumar A et al. Post kala-azar dermal leishmaniasis in the Indian sub-continent: challenges and strategies for elimination. Front Immunol. 2023. PMID: 37638047. doi: 10.3389/fimmu.2023.1236952. PubMed: https://pubmed.ncbi.nlm.nih.gov/37638047/
- 2 Wilhelm TJ et al. [Visceral leishmaniasis]. Chirurg. 2019 Oct. PMID: 31297548. doi: 10.1007/s00104-019-0994-1. PubMed: https://pubmed.ncbi.nlm.nih.gov/31297548/
- 3 Zijlstra EE et al. Biomarkers in Post-kala-azar Dermal Leishmaniasis. Front Cell Infect Microbiol. 2019. PMID: 31417876. doi: 10.3389/fcimb.2019.00228. PubMed: https://pubmed.ncbi.nlm.nih.gov/31417876/
- 4 Vijayakumar S et al. A review of non-invasive samples and tools in kala-azar diagnosis and test of cure. Exp Parasitol. 2024 Apr. PMID: 38350522. doi: 10.1016/j.exppara.2024.108713. PubMed: https://pubmed.ncbi.nlm.nih.gov/38350522/
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DOI 10.1016/s1473-3099(24)00420-1 ↗ Effect of indoor residual spraying on sandfly abundance and incidence of visceral leishmaniasis in India, 2016–22: an interrupted time-series analysis and modelling study
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PLOS Neglected Tropical Diseases
Évalué par les pairs Accès ouvert Association à vérifier Leishmaniose viscérale (kala-azar) Dynamique de transmission
DOI 10.1016/s2666-5247(20)30166-x ↗ Xenodiagnosis to evaluate the infectiousness of humans to sandflies in an area endemic for visceral leishmaniasis in Bihar, India: a transmission-dynamics study
The Lancet Microbe
Évalué par les pairs Accès ouvert Association forte à la maladie Leishmaniose viscérale (kala-azar) Enquête sur une flambée
DOI 10.1186/s12879-019-4719-3 ↗ Intensely clustered outbreak of visceral leishmaniasis (kala-azar) in a setting of seasonal migration in a village of Bihar, India
BMC Infectious Diseases
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