Abstract
Leishmaniasis is a major vector-borne disease caused by obligate intramacrophage protozoa of the genus Leishmania, and transmitted by the bite of phlebotomine female sand flies of the genera Phlebotomus and Lutzomyia, in the old and new worlds, respectively. Among 20 well-recognized Leishmania species known to infect humans, 18 have zoonotic nature, which include agents of visceral, cutaneous, and mucocutaneous forms of the disease, in both the old and new worlds. Currently, leishmaniasis show a wider geographic distribution and increased global incidence. Environmental, demographic and human behaviors contribute to the changing landscape for zoonotic cutaneous and visceral leishmaniasis. The primary reservoir hosts of Leishmania are sylvatic mammals such as forest rodents, hyraxes and wild canids, and dogs are the most important species among domesticated animals in the epidemiology of this disease. These parasites have two basic life cycle stages: one extracellular stage within the invertebrate host (phlebotomine sand fly), and one intracellular stage within a vertebrate host. Co-infection with HIV intensifies the burden of visceral and cutaneous leishmaniasis by causing severe forms and more difficult to manage. The disease is endemic to Ethiopia, and the clinical signs are not pathognomic. The visceral form (Kala-azar) may be confused with other similar conditions such as malaria, tropical splenomegaly, schistosomiasis, milliary tuberculosis, and brucellosis. Similarly, cutaneous leishmaniasis should be differentiated from disease like tropical ulcers, impetigo and leprosy. There are several methods of laboratory diagnosis of leishmaniasis, including parasitological, immunological and molecular. Different forms of treatments are available including oral, parenteral, and topical medications such as pentavalent antimonials, liposomal amphotericin B, miltefosine and paromomycin. Methods of control are largely limited to destruction of animal reservoirs, treatment of infected humans, and management of sand fly populations. Development of an effective vaccine against leishmaniasis has been largely unsuccessful and hinders its prevention.
Highlights
Leishmaniasis is a major vector-borne metazoonosis disease [1], caused by obligate intramacrophage protozoa of the genus Leishmania [2]
In foci of cutaneous leishmaniasis caused by L. aethiopica in the highlands of Ethiopia and other places in East Africa, increased human fly contact occurs in villages built on rock hills or river banks, which are the natural habitat of hyraxes
Leishmaniasis is caused by a protozoan parasite
Summary
Leishmaniasis is a major vector-borne metazoonosis disease [1], caused by obligate intramacrophage protozoa of the genus Leishmania [2]. In foci of cutaneous leishmaniasis caused by L. aethiopica in the highlands of Ethiopia and other places in East Africa, increased human fly contact occurs in villages built on rock hills or river banks, which are the natural habitat of hyraxes (reservoir hosts). Protein-energy malnutrition has been associated with an increased risk for mucocutaneous leishmaniasis [22,28] Epidemics of both visceral and cutaneous leishmaniasis, in both the old and the new world, are often associated with migration and the introduction of non-immune people into areas with existing endemic or enzootic transmission cycles. Prediction of such outbreaks depends on the availability of ecological information, and on evaluation of development areas, before implementation of projects or population movements [11]. Animal inoculation into hamsters may be valuable, especially with contaminated material [42,43]
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