Cutaneous and Visceral Leishmaniasis Treatment: A Look at These Neglected Tropical Diseases
What is Leishmaniasis?
Leishmaniasis refers to a group of parasitic diseases that are spread by the bite of certain types of sandflies. There are over 20 different species of Leishmania parasites that can cause disease in humans. The most common forms of leishmaniasis are cutaneous leishmaniasis and visceral leishmaniasis.
Cutaneous Leishmaniasis
Cutaneous leishmaniasis (CL) is the most common form of the disease. It causes skin sores or lesions that may occur from several months to over a year after the bite of an infected sandfly. The sores can develop in places where the infected sandfly bit and may be single or multiple. They can range in severity from a small localized skin sore to large, disfiguring lesions. CL usually heals spontaneously within months but can leave disfiguring scars. Over 1 million new cases are estimated to occur each year.
CL is found mainly in parts of Latin America, the Mediterranean, the Middle East and Central Asia. The parasites that cause CL vary between different geographic areas. The most common parasites in Latin America are Leishmania mexicana and Leishmania braziliensis. In the Old World, diseases caused by Leishmania major and Leishmania tropica predominate.
Visceral Leishmaniasis
Visceral leishmaniasis (VL), also known as kala-azar, is the most severe form of the disease. It affects internal organs such as the spleen, liver and bone marrow. If left untreated, VL is almost always fatal. The parasite, Leishmania donovani, spreads via the bloodstream to inner organs. Early symptoms of VL are similar to flu - fever, weight loss, enlargement of the spleen and liver, and anemia. Without Leishmaniasis Treatment, disease progresses rapidly and death usually occurs within months. About 90% of global VL cases occur in just six countries - Bangladesh, Brazil, Ethiopia, India, South Sudan and Sudan.
Treatment of Leishmaniasis
There are treatments available for leishmaniasis, but challenges remain regarding drug efficacy, toxicity and availability. For uncomplicated CL, topical treatments such as paromomycin ointment or oral medications such as miltefosine are generally effective. For severe or complicated cases, systemic drugs such as liposomal amphotericin B are needed. VL requires parenteral drugs such as liposomal amphotericin B or miltefosine for 15-30 days. However, treatment failures commonly occur for all forms of the disease.
Several drugs are highly toxic and therefore require medical supervision, especially for VL. Treatment costs are prohibitive for many in endemic areas. New oral drugs are being tested, but more research is still needed. Drug resistance is emerging, particularly in Bihar, India where most global VL cases occur. Furthermore, co-infections with HIV are increasing treatment complexities.
Disease Impacts
Leishmaniasis has significant impacts on populations living in endemic areas. Disabilities from disfiguring scars or advanced VL create immense economic and psychosocial burdens. Most disease is concentrated in poor, remote communities with limited access to diagnosis and treatment. Each year, leishmaniasis claims over 20,000-40,000 lives and causes over 2.4 million disability-adjusted life years lost. The at-risk population totals 350 million. Children under 15 years are especially vulnerable to disease. Poverty, conflict, deforestation, migration and lack of disease control programs worsen impacts.
There is urgent need for action to address the widespread disease burdens caused by this neglected group of tropical infections. Improved diagnostics, safer and more effective drugs, affordable treatment approaches, stronger surveillance and control strategies are critically needed. Governments and international funders must prioritize leishmaniasis control within their investments in neglected tropical disease programs. With sustained commitment and action, the public health impacts of leishmaniasis can be greatly reduced.
Sandfly Vector Control
Controlling the sandfly vectors that spread Leishmania parasites offers an important strategy for reducing disease risk. Sandflies breed in soil near rodent burrows and plant roots and bushes providing ideal humid conditions. Integrated vector management programs utilize targeted sandfly surveillance to identify and treat breeding hotspots. Indoor residual spraying (IRS) with residual insecticides in high transmission villages remains a core strategy. Promoting land management practices to reduce sandfly habitats also supports control efforts. However, limited program coverage and resources allow vectors to readily repopulate areas. Novel control tools are being explored to supplement conventional approaches. Community engagement and multi-sector coordination are essential for sustainable sandfly and leishmaniasis control.
leishmaniasis comprises a diverse group of parasitic diseases that impose substantial health and socioeconomic burdens, especially in poor developing countries. Cutaneous and visceral forms are caused by different Leishmania species spread by certain sandfly vectors. While treatments are available, many challenges remain regarding drug access, efficacy and emerging resistance. Vector control efforts are mainstay but require strengthened program implementation and coordination across impacted sectors. Increased investment from global health partners is urgently needed to roll out improved diagnostics, treatments and control strategies, bringing leishmaniasis out of neglect. With a concerted international response, significant progress can be achieved against this important cluster of tropical diseases.
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