Leishmaniasis

Abstract

I congratulate Sakib Burza and colleagues (Sept 15, 2018, p 951)1Burza S Croft SL Boelaert M Leishmaniasis.Lancet. 2018; 392: 951-970Summary Full Text Full Text PDF PubMed Scopus (867) Google Scholar for their comprehensive Seminar on leishmaniasis. I would like to comment on the 3-month duration of contraceptive cover for women of reproductive age (15–49 years), mentioned in Table 3,1Burza S Croft SL Boelaert M Leishmaniasis.Lancet. 2018; 392: 951-970Summary Full Text Full Text PDF PubMed Scopus (867) Google Scholar for the 28-day treatment with miltefosine for visceral leishmaniasis. Although this contraception cover appears to be in agreement with Indian programme guidelines recommending it during and 2 months following treatment,2Directorate of National Vector Borne Disease Control ProgrammeNational roadmap for kala-azar elimination August 2014. Government of India, New Delhi2014Google Scholar WHO guidelines published in 2010 recommend contraceptive cover during and 3 months after treatment (ie, a total duration of approximately 4 months).3WHOControl of the Leishmaniases—report of a meeting of the WHO Expert Committee on the Control of Leishmaniases, Geneva, 22–26 March 2010. World Health Organization, Geneva2010Google Scholar Furthermore, a pharmacokinetic modelling study published in 2012 had recommended contraceptive cover to be extended to 4 months after treatment completion.4Dorlo TPC Balasegaram M Lima MA de Vries PJ Beijnen JH Huitema ADR Translational pharmacokinetic modelling and simulation for the assessment of duration of contraceptive use after treatment with miltefosine.J Antimicrob Chemother. 2012; 67: 1996-2004Crossref PubMed Scopus (27) Google Scholar Therefore, a total contraceptive cover of about 5 months (28 days during treatment and 4 months after treatment) might be preferred to sufficiently minimise the risk of teratogenicity with miltefosine treatment. Additionally, Table 3 mentions that Impavido is the only WHO prequalified preparation of miltefosine. However, information available at the WHO website does not mention Impavido or any miltefosine preparation as one of their prequalified preparations. In the Seminar, the authors also have mentioned that empirical evidence and recent observational studies stress the importance of transmission from clinical cases and post-kala-azar dermal leishmaniasis cases. However, the article5Das VNR Pandey RN Siddiqui NA et al.Longitudinal study of transmission in households with visceral leishmaniasis, asymptomatic infections and PKDL in highly endemic villages in Bihar, India.PLoS Negl Trop Dis. 2016; 10: e0005196Crossref PubMed Scopus (29) Google Scholar cited to support this statement concludes that the study did not provide evidence that post-kala-azar dermal leishmaniasis represents a risk factor for development of visceral leishmaniasis or becoming asymptomatic rK39-positive. In fact, that study found that seroconversion with rK39 rapid test (that measures antibodies against the antigen of Leishmania donovani parasite) was lower, although not significantly, in households with patients with post-kala-azar dermal leishmaniasis compared with control households (0·39% vs 0·64% at 18 months follow-up; Fisher's exact test p=0·762), which were seronegative for rK39 rapid test at baseline.5Das VNR Pandey RN Siddiqui NA et al.Longitudinal study of transmission in households with visceral leishmaniasis, asymptomatic infections and PKDL in highly endemic villages in Bihar, India.PLoS Negl Trop Dis. 2016; 10: e0005196Crossref PubMed Scopus (29) Google Scholar Therefore, contrary to the authors' contention, the role of post-kala-azar dermal leishmaniasis in maintaining visceral leishmaniasis transmission in the community is not supported by the cited evidence. I declare no competing interests. This Correspondence was written in a personal capacity, using publicly available information, and does not necessarily reflect the offical view of WHO. LeishmaniasisLeishmaniasis is a poverty-related disease with two main clinical forms: visceral leishmaniasis and cutaneous leishmaniasis. An estimated 0·7–1 million new cases of leishmaniasis per year are reported from nearly 100 endemic countries. The number of reported visceral leishmaniasis cases has decreased substantially in the past decade as a result of better access to diagnosis and treatment and more intense vector control within an elimination initiative in Asia, although natural cycles in transmission intensity might play a role. Full-Text PDF LeishmaniasisSakib Burza and colleagues1 infer that no autochtonous cases of visceral leishmaniasis have been reported in Thailand. Several cases of visceral leishmaniasis, however, have been recorded in this country in the past few years.2 All these cases were caused by Leishmania (Mundinia) martiniquensis except one, which was caused by L (Mundinia) siamensis.2 A new autochtonous species causing cutaneous leishmaniasis, L (Mundinia) orientalis, has also been described in Thailand in 2018,3 so three species of Leishmania are now known to cause leishmaniasis in this country. Full-Text PDF LeishmaniasisSakib Burza and colleagues1 adeptly reviewed different aspects of visceral leishmaniasis and cutaneous leishmaniasis. Full-Text PDF Leishmaniasis – Authors' replyWe share the concern raised by Suman Saurabh about duration of contraception when miltefosine is used as a treatment for leishmaniasis, since it is a major gap in clinical practice. Full-Text PDF