Journal of Global Infectious DiseasesOfficial Publishing of International Infectiologists Network Users online:21  
Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size     
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 
 


 
SYMPOSIUM - LIESHMANIASIS Table of Contents   
Year : 2010  |  Volume : 2  |  Issue : 2  |  Page : 124-126
A current perspective on leishmaniasis


Department of Global Health, MDC 56 College of Public Health, 12901 Bruce B Downs Blvd, Tampa, USA

Click here for correspondence address and email

Date of Web Publication30-Apr-2010
 

   Abstract 

There are many challenges facing the successful control and eradication of cutaneous and visceral leishmaniasis. Leishmaniasis is still endemic in many poverty stricken and war torn areas. Through the use of an extensive literature review, this article examined the global disease burden of cutaneous and visceral leishmaniasis. Surveillance and control measures for leishmaniasis being used by the World Health Organization were also discussed in this article. Finally, potential new treatments and possible vaccines for leishmaniasis were reviewed in this article.

Keywords: Cutaneous leishmaniasis, Visceral leishmaniasis, Treatments, Vaccines

How to cite this article:
Clem A. A current perspective on leishmaniasis. J Global Infect Dis 2010;2:124-6

How to cite this URL:
Clem A. A current perspective on leishmaniasis. J Global Infect Dis [serial online] 2010 [cited 2014 Sep 30];2:124-6. Available from: http://www.jgid.org/text.asp?2010/2/2/124/62863


The articles in the symposium provide a current perspective on the global disease burden of leishmaniasis. These articles also cover control and surveillance measures being used for leishmaniasis and new research on leishmaniasis. This cutting edge research includes potential new treatments as well as possible vaccines for leishmaniasis.

Leishmaniasis is a parasitic disease caused by obligate intracellular protozoans from the genus Leishmania. Leishmania donovani and L. infantum/L. chagasi are commonly the species that are implicated in the disease. These protozoans are typically spread through the bite of infected female phlebotomine sand flies; although congenital and blood-borne transmission has been documented. Leishmaniasis typically presents as one of the two forms, either cutaneous or visceral. Cutaneous leishmaniasis produces skin ulcerations with raised borders which may last months to years and typically result in severe scarring.[1] In contrast, visceral leishmaniasis affects the internal organs especially the spleen, liver, and bone marrow. Latent cases may remain undiagnosed from years to decades until the individual becomes immunocompromised (especially with HIV) then the individual will typically develop fever, weight loss, hepatosplenomegaly, and pancytopenia. Severe cases of visceral leishmaniasis left untreated are commonly fatal. [2] Although there are treatments for leishmaniasis (such as liposomal amphotericin B for visceral leishmaniasis and pentavalent antimonial compound sodium stibogluconate (Pentostam) for cutaneous leishmaniasis), there are no preventive medications or vaccinations for the disease. [1],[2]

Leishmaniasis has been greatly underreported for innumerable years. This underestimation of the true health burden of leishmaniasis is due to several reasons. First, reporting of the disease is only mandatory in 32 of the 88 countries affected by leishmaniasis. The WHO has estimated that 2 million new cases occur yearly (1.5 million for cutaneous leishmaniasis and 500,000 for visceral leishmaniasis) and that 12 million people are infected globally. [3]

Next, because leishmaniasis is a disease of poverty, which produces high morbidity but low mortality and results in stigma-producing deformities, it is a disease that is typically kept hidden by the affected individuals and their families. In addition, economic troubles, civil war, and drought with its accompanying starvation have contributed greatly to the spread of leishmaniasis and the continued underreporting of the actual impact of the disease. For example, an epidemic of visceral leishmaniasis was carried into Eritea and Ethiopia in 1997 from neighboring Sudan by migrating farm laborers and refugees fleeing civil unrest in Sudan. Sudan had previously been experiencing a decade-long epidemic of visceral leishmaniasis due to continuing malnutrition and civil unrest. sup> [3]


   Leishmaniasis Surveillance and Control Top


The World Health Organization (WHO) network for leishmaniasis surveillance and control aims to reduce the incidence of disease so that these surveillance and control measures can be integrated into each country's health development activities. This network has been extended to include six new institutions from Sudan, Brazil, China, India, Nepal, and Kenya. The overall goals of this network include early diagnosis and treatment including coinfections with HIV, control of sand fly populations through residual insecticide spraying in houses and insecticide-impregnated bed nets, health education and training, and control of epidemics. [4]

As for ongoing research, the WHO has noted improvements with the direct agglutination test with freeze-dried antigen and antigen detection from urine using dipsticks K39/K26. The dipstick K39 was used successfully for serological diagnosis in Sudan, Nepal, India, and Ethiopia. Also, there are ongoing programs for comparing diagnostic testing for visceral leishmaniasis in the field. Also, insecticide-impregnated bed nets were used successfully in Syria to produce a 50% reduction in cutaneous leishmaniasis. In March 2002, India registered the first oral drug, miltefosine, for the treatment of visceral leishmaniasis. The drug has shown cure rates of up to 98%, does not require refrigeration, and can be used to treat cases resistant to conventional antimony therapy; however, there are some potential gastrointestinal side effects, and the medication is a potential teratogen. [5]

More recent research has examined potential new medications for the treatment of leishmaniasis or potential vaccines for the disease. Wang et al. studied the use of arylimidamides, DB745 and DB 766, as potential oral treatments for L. donovani axenic amastigotes, and intracellular Leishmania. Both compounds produced dose-dependent inhibition of liver parasitemia in mice and hamster models. DB766 was also shown to reduce parasitemia in the spleen and bone marrow in the hamster model. [6]

Research by Banerjee et al. studied the relationship of membrane fluidity of antigen-presenting cells (APCs) with defective cell-mediated immunity in visceral leishmaniasis. Using a Leishmania donovani-infected hamster model, the authors found that systemic administration of cholesterol liposomes cured the infection. The cholesterol liposomes corrected the decreased membrane cholesterol of the APCs which allowed the APCs to properly stimulate T-cells and clear the infection. [7]

Mendez et al. examined the effect of pyrazinamide on the survival of leishmania major promastigotes and amastigotes. The promastigotes were more sensitive than the amastigotes to the drug. With prolonged treatment, there was increased parasite elimination. It was also noted that the pyrazimamide produced collateral immunostimulation and may be a potential antileishmanial therapy. [8]

Serrano-Martνn et al. studied the effects of combining amiodarone and miltefosine against Leishmania mexicana promastigotes and intracellular amastigotes. The authors had previously demonstrated that the antiarrhythmic medication amiodarone disrupted the intracellular Ca 2+ homeostasis of the parasites thus inhibiting their de novo sterol biosynthesis. In this study, the authors found that miltefosine also disrupted the intracellular Ca 2+ homeostasis of the parasites. Synergistic use of amiodarone and miltefosine affected the proliferation of intracellular amastigotes inside macrophages and led to a 90% cure in a mouse model. [9]

Recent research has also examined the cellular and humoral immune responses of healed cutaneous leishmaniasis and visceral leishmaniasis. The study examined the effects of two virulence proteins, L. major protein disulfide isomerase (LmPDI) and mitogen-activated protein kinase kinase (MAPKK) on immune responses. MAPKK was found to induce elevated peripheral blood mononuclear cell proliferation, elevated gamma interferon production, and antibody responses. In the study authors theorized that these results may be useful for leishmaniasis vaccination and serodiagnosis. [10]

In summary, there are many challenges facing the successful control and eradication of cutaneous and visceral leishmaniasis. Leishmaniasis is still endemic in many poverty stricken and war torn areas. However, there is continuing research into the treatment of leishmaniasis and potentially vaccinations for the disease.

 
   References Top

1.Herwaldt BL, Magill AJ. Chapter 5 Leishmaniasis, cutaneous. 2010 Yellow Book. CDC Travelers′ Health. Available from: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/cutaneous-leishmaniasis.aspx. [cited in 2010].  Back to cited text no. 1      
2.Herwaldt BL, Magill AJ. Chapter 5 Leishmaniasis, visceral. 2010 Yellow book. CDC Travelers′ Health. Available from: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/visceral-leishmaniasis.aspx. [cited in 2010].  Back to cited text no. 2      
3.WHO. Leishmaniasis magnitude of the problem. Available from: http://www.who.int/leishmaniasis/burden/magnitude/burden_magnitude/en/print.html. [cited in 2010].  Back to cited text no. 3      
4.WHO. Leishmaniasis surveillance and control of leishmaniasis. Available from: http://www.who.int/entity/leishmaniasis/surveillance/en/. [cited in 2010]  Back to cited text no. 4      
5.WHO. Leishmaniasis research on leishmaniasis. Available from: http://www.who.int/entity/leishmaniasis/research/en/. [cited in 2010].  Back to cited text no. 5      
6.Wang MZ, Zhu X, Srivastava A, Liu Q, Sweat JM, Pandharkar T, et al. Novel arylimidamides for the treatment of visceral leishmaniasis. Antimicrob Agents Chemother 2010;54: in press.  Back to cited text no. 6      
7.Banerjee S, Ghosh J, Sen S, Guha R, Dhar R, Ghosh M, et al. Designing therapies against experimental visceral leishmaniasis by modulating the membrane fluidity of antigen-presenting cells. Infect Immun 2009;77: 2330-42.  Back to cited text no. 7      
8.Mendez S, Traslavina R, Hinchman M, Huang L, Green P, Cynamon MH, et al. The antituberculosis drug pyrazinamide affects the course of cutaneous leishmaniasis in vivo and increases activation of macrophages and dendritic cells. Antimicrob Agents Chemother 2009;53:5114-21.  Back to cited text no. 8      
9.Serrano-Martνn X, Payares G, de Lucca M, Martinez JC, Mendoza-Leσn A, Benaim G. Amiodarone and miltefosine act synergistically against Leishmania mexicana and can induce parasitological cure in a murine model of cutaneous leishmaniasis. Antimicrob Agents Chemother 2009;53: 5108-13.  Back to cited text no. 9      
10.Lakhal-Naouar I, Boussoffara T, Meddeb-Garnaoui A, Ben Achour-Chenik Y, Louzir H, Chenik M. Cellular and humoral responses to Leishmania major virulence factors in healed cutaneous leishmaniasis and Mediterranean visceral leishmaniasis patients. Clin Vaccine Immunol 2009;16:956-8.  Back to cited text no. 10      

Top
Correspondence Address:
Angela Clem
Department of Global Health, MDC 56 College of Public Health, 12901 Bruce B Downs Blvd, Tampa
USA
Login to access the Email id


DOI: 10.4103/0974-777X.62863

PMID: 20606967

Get Permissions




This article has been cited by
1 Discovery of novel anti-leishmanial agents targeting LdLip3 Lipase
Author: Saravanan Parameswaran,Prakash Saudagar,Vikash Kumar Dubey,Sanjukta Patra
Journal of Molecular Graphics and Modelling. 2014;
[Pubmed]
2 Immunity to visceral leishmaniasis: implications for immunotherapy
Forough Khadem,Jude E Uzonna
Future Microbiology. 2014; 9(7): 901
[Pubmed]
3 Activity of melatonin against Leishmania infantum promastigotes by mitochondrial dependent pathway
Ehab Kotb Elmahallawy,Aroa Jiménez-Aranda,Antonio Sampedro Martínez,Javier Rodriguez-Granger,Miguel Navarro–Alarcón,Jose Gutiérrez Fernández,Ahmad Agil
Chemico-Biological Interactions. 2014;
[Pubmed]
4 An unusual case of anaemia in an octogenarian
L. McCusker,J. Platt
Age and Ageing. 2012; 41(5): 696
[Pubmed]
5 Leishmaniasis with oral mucosa involvement
Ana C. A. Pellicioli,Marco A. T. Martins,Manoel Sant’ana Filho,Pantelis V. Rados,Manoela D. Martins
Gerodontology. 2012; 29(2): e1168
[Pubmed]
6 MRI-findings of nodular lesions in an enlarged spleen, associated with visceral Leishmaniasis
Steven Raeymaeckers,Martine Docx,Nathan Demeyere
European Journal of Radiology. 2012; 81(10): 2550
[Pubmed]
7 Leishmania amazonensis: Effects of oral treatment with copaiba oil in mice
Adriana Oliveira dos Santos,Marco Antonio Costa,Tânia Ueda-Nakamura,Benedito Prado Dias-Filho,Valdir Florêncio da Veiga-Júnior,Marli Miriam de Souza Lima,Celso Vataru Nakamura
Experimental Parasitology. 2011; 129(2): 145
[Pubmed]



 

Top
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Leishmaniasis Su...
    References

 Article Access Statistics
    Viewed2399    
    Printed159    
    Emailed4    
    PDF Downloaded299    
    Comments [Add]    
    Cited by others 7    

Recommend this journal

Sitemap | What's New | Feedback | Copyright and Disclaimer | Contact Us
© 2008 Journal of Global Infectious Diseases | Published by Medknow
Online since 10th December, 2008