VL Cases Research Articles

An epidemiological and spatiotemporal analysis of visceral leishmaniasis in West Pokot, Kenya, between 2018 and 2022

BackgroundVisceral leishmaniasis (VL) remains a significant public health concern in West Pokot County, Kenya, where a large outbreak between 2020 and 2022 emphasised the need for improved VL control strategies. However, these measures are partially hampered by limited insight into the geographical distribution of cases and localised outbreaks of the disease. This study aimed to describe the epidemiology and spatiotemporal patterns of VL in West Pokot between 2018 and 2022, in order to map the spread of VL transmission and identify regions that should be prioritised for control interventions.MethodsVL patient demographics and village of residence were retrieved from admission records of Kacheliba Sub-County Hospital in West Pokot, Kenya. The temporal trend in VL admissions between 2018 and 2022 was analysed using seasonal decomposition analysis. To describe the spatial distribution of VL cases, geographic coordinates of villages of residence were collected from pre-established databases, and VL incidence was mapped at the sub-location level. Hotspot analysis was performed per study year to identify villages with high VL incidence, and scan statistics were applied to detect spatiotemporal clusters of VL cases during the study period.ResultsA total of 1948 VL patients were reported between 2018 and 2022. The annual number of cases increased from 245 in 2019 to 598 in 2022, and VL admissions were generally higher at the start of the wet seasons. 70% of the VL cases could be georeferenced, and mapping of VL incidence revealed high case rates in the east of West Pokot during the complete study period. The eastern villages Lotongot and Chepaywat were marked as VL hotspots at a 99% confidence level in all study years. In addition, five significant spatiotemporal clusters were detected in the east and north, suggestive of local VL outbreaks in these regions.ConclusionsThe increase in VL hospital admissions during the study period stresses the need for enhanced VL control and outbreak mitigation in West Pokot. These control measures should be focused on the hotspot regions in the east of the county.

Challenges for maintaining post elimination phase of visceral leishmaniasis control programme in India: A field-based study.

India is going through the maintenance phase of VL elimination programme which may be threatened by the persistence of hidden parasite pools among asymptomatic leishmanial infection (ALI) and PKDL. The present work was designed to determine the burden of VL, PKDL, and ALI and to assess the role of treatment of ALI in maintaining post-elimination phase. The study was undertaken in Malda district, West Bengal, India during October 2016 to September 2021. Study areas were divided into 'Study' and 'Control' arms. VL and PKDL cases of both the arms were diagnosed by three active mass surveys with an interval of one year and treated as per National guideline. ALI of 'Study' arm was treated like VL. ALI of 'Control' arm was followed up to determine their fate. Fed sand-fly pools were analysed for parasitic DNA. No significant difference was noted between the incidence of VL and PKDL in both the arms. Incidence of ALI declined sharply in 'Study' arm but an increasing trend was observed in 'Control' arm. Significantly higher rate of sero-conversion was noted in 'Control' arm and was found to be associated with untreated ALI burden. Parasitic DNA was detected in 22.8% ALI cases and 2.2% sand-fly pools. Persistence of a significant number of PKDL and ALI and ongoing transmission, as evidenced by new infection and detection of leishmanial DNA in vector sand-flies, may threaten the maintenance of post-elimination phase. Emphasis should be given for elimination of pathogen to prevent resurgence of VL epidemics.

Portable smartphone-based molecular test for rapid detection of Leishmania spp.

PurposeLeishmaniasis, caused by the parasite of the genus Leishmania, is a neglected tropical disease which is endemic in more than 60 countries. In South-East Asia, Brazil, and East Africa, it mainly occurs as kala-azar (visceral leishmaniasis, VL), and subsequently as post kala-azar dermal leishmaniasis (PKDL) in a smaller portion of cases. As stated per WHO roadmap, accessibility to accurate diagnostic methods is an essential step to achieve elimination. This study aimed to test the accuracy of a portable minoo device, a small battery-driven, multi-use fluorimeter operating with isothermal technology for molecular diagnosis of VL and PKDL.MethodsFluorescence data measured by the device within 20 min are reported back to the mobile application (or app) via Bluetooth and onward via the internet to a backend. This allows anonymous analysis and storage of the test data. The test result is immediately returned to the app displaying it to the user.ResultsThe limit of detection was 11.2 genome copies (95% CI) as determined by screening a tenfold dilution range of whole Leishmania donovani genomes using isothermal recombinase polymerase amplification (RPA). Pathogens considered for differential diagnosis were tested and no cross-reactivity was observed. For its diagnostic performance, DNA extracted from 170 VL and PKDL cases, comprising peripheral blood samples (VL, n = 96) and skin biopsies (PKDL, n = 74) from India (n = 108) and Bangladesh (n = 62), was screened. Clinical sensitivity and specificity were 88% and 91%, respectively.ConclusionMinoo devices can offer a convenient, cheaper alternative to other molecular diagnostics. Its easy handling makes it ideal for use in low-resource settings to identify parasite burden.

Impact of the COVID-19 Pandemic Surveillance of Visceral Leishmaniasis in Brazil: An Ecological Study.

The aim of the study was to assess the impact of the COVID-19 pandemic on the notification of new VL cases in Brazil in 2020. It is an ecological and time-series study (2015-2020) with spatial analysis techniques, whose units of analysis were the 5570 Brazilian municipalities. The study population consisted of all new cases of VL recorded between 2015 and 2020. The P-score was calculated to estimate the percentage variation in new VL cases. Global and local univariate Moran's Indices and retrospective space-time scan statistics were used in spatial and space-time analyses, respectively. It was expected that there would be 3627 new cases of VL in Brazil in 2020, but 1932 cases were reported (-46.73%). All Brazilian regions presented a negative percentage variation in the registration of new VL cases, with the Southeast (-54.70%), North (-49.97%), and Northeast (-44.22%) standing out. There was spatial dependence of the disease nationwide in both periods, before and during the first year of the COVID-19 pandemic. There was a significant reduction in the incidence of new VL cases in Brazil during the first year of the COVID-19 pandemic. These findings reinforce the need for better preparedness of the health system, especially in situations of new epidemics.

Spatio-temporal analysis of the visceral leishmaniasis in the state of Alagoas, Brazil.

Visceral leishmaniosis is a neglected tropical disease. We evaluated the spatial distribution of cases of visceral leishmaniosis in the state of Alagoas, Brazil. All cases of VL, registered by the health department, were analyzed and georeferenced. Results: Between 2008 and 2017, 97.1% of the municipalities presented sporadic classification of transmission. With temporal evolution, the incidence of cases of visceral leishmaniosis was concentrated in most municipalities in the microregion of Santana do Ipanema-AL. Space-time analysis, if considered, may promote the improvement of surveillance and control actions of visceral leishmaniosis.

Experimental structure based drug design (SBDD) applications for anti-leishmanial drugs: A paradigm shift?

Leishmaniasis is a group of neglected tropical diseases caused by at least 20 species of Leishmania protozoa, which are spread by the bite of infected sandflies. There are three main forms of the disease: cutaneous leishmaniasis (CL, the most common), visceral leishmaniasis (VL, also known as kala-azar, the most serious), and mucocutaneous leishmaniasis. One billion people live in areas endemic to leishmaniasis, with an annual estimation of 30,000 new cases of VL and more than 1 million of CL. New treatments for leishmaniasis are an urgent need, as the existing ones are inefficient, toxic, and/or expensive. We have revised the experimental structure-based drug design (SBDD) efforts applied to the discovery of new drugs against leishmaniasis. We have grouped the explored targets according to the metabolic pathways they belong to, and the key achieved advances are highlighted and evaluated. In most cases, SBDD studies follow high-throughput screening campaigns and are secondary to pharmacokinetic optimization, due to the majoritarian belief that there are few validated targets for SBDD in leishmaniasis. However, some SBDD strategies have significantly contributed to new drug candidates against leishmaniasis and a bigger number holds promise for future development.

The ongoing risk of Leishmania donovani transmission in eastern Nepal: an entomological investigation during the elimination era

BackgroundVisceral leishmaniasis (VL), a life-threatening neglected tropical disease, is targeted for elimination from Nepal by the year 2026. The national VL elimination program is still confronted with many challenges including the increasingly widespread distribution of the disease over the country, local resurgence and the questionable efficacy of the key vector control activities. In this study, we assessed the status and risk of Leishmania donovani transmission based on entomological indicators including seasonality, natural Leishmania infection rate and feeding behavior of vector sand flies, Phlebotomus argentipes, in three districts that had received disease control interventions in the past several years in the context of the disease elimination effort.MethodsWe selected two epidemiologically contrasting settings in each survey district, one village with and one without reported VL cases in recent years. Adult sand flies were collected using CDC light traps and mouth aspirators in each village for 12 consecutive months from July 2017 to June 2018. Leishmania infection was assessed in gravid sand flies targeting the small-subunit ribosomal RNA gene of the parasite (SSU-rRNA) and further sequenced for species identification. A segment (~ 350 bp) of the vertebrate cytochrome b (cytb) gene was amplified from blood-fed P. argentipes from dwellings shared by both humans and cattle and sequenced to identify the preferred host.ResultsVector abundance varied among districts and village types and peaks were observed in June, July and September to November. The estimated Leishmania infection rate in vector sand flies was 2.2% (1.1%–3.7% at 95% credible interval) and 0.6% (0.2%–1.3% at 95% credible interval) in VL and non-VL villages respectively. The common source of blood meal was humans in both VL (52.7%) and non-VL (74.2%) villages followed by cattle.ConclusionsOur findings highlight the risk of ongoing L. donovani transmission not only in villages with VL cases but also in villages not reporting the presence of the disease over the past several years within the districts having disease elimination efforts, emphasize the remaining threats of VL re-emergence and inform the national program for critical evaluation of disease elimination strategies in Nepal.Graphical 

Perfil epidemiológico das notificações de leishmaniose no estado de Pernambuco no Brasil de 2015-2019

Here, we provide an epidemiological analysis of leishmaniasis in Pernambuco, Brazil, from 2015 to 2019. Our results revealed 1,705 of American cutaneous leishmaniasis-ACL and 859 cases of visceral leishmaniasis-VL. VL and ACL affect children aged 1–4 years (23% and 3.2% of all cases, respectively) and adults aged 20–39 years (26% and 28%, respectively), mainly women. The highest percentage (54.6%) of VL cases was found in urban areas, while ACL occurred mainly in rural areas (63.2%). Individuals with a higher level of education were less affected by leishmaniasis and data on prognosis revealed good chances of clinical cure, but deaths are still recorded. These data show that preventive health actions must be developed to hinder leishmaniasis spread, reduce its impact on public health, and restore the population's life quality. This study can be useful in further elaboration of strategies to minimize leishmaniasis impacts.

Clinical features, immunological interactions and household determinants of visceral leishmaniasis and malaria coinfections in West Pokot, Kenya: protocol for an observational study

IntroductionVisceral leishmaniasis (VL) and malaria are two deadly parasitic diseases that coexist in West Pokot County, Kenya. The local population is at considerable risk of coinfection with VL and malaria;...

Reproducibility of the new Leishmania vaccine: Changes in T1, T2 and spleen white pulp responses after re- exposure to live promastigote of Leishmania major

Introduction: Human leishmaniasis is distributed worldwide and is mainly in the tropics and subtropics, with a prevalence of 12 million cases and an approximately incidence of 0.5 million cases of VL and 1.5 million cases of cutaneous leishmaniasis (CL). Leishmania parasites are vector-born protozoan pathogens found in tropical and subtropical regions of both the old and new world. The disease in human can be divided into cutaneous, visceral, and mucosal syndromes. The aim of this study was more experiments over our previous new formulation leishmania major vaccine which had satisfactory experiments results. Method: For detail procedure refers to author’s previous publications. Briefly, hundred and twenty Balb/cmice were randomly divided into four groups as LT, LB, LBT and control groups. LT, LB and LBT injected subcutaneously with the antigen and the same booster doses with two weeks intervals. The expansion rates of the spleen white pulp size was evaluated using a light microscope and the levels of the serum Th1 (IFN- γ, IL-12) and Th2 (IL-4, IL-10) cytokines measured with the ELISA method. Results: Comparing to the LT and LB groups, the LBT group had highest levels of serum IL12, lowest levels of IL10 and highest increase in the spleen white pulp size. Significant correlation was observed between IL12 and IL10 but not IFN gamma or IL4. Conclusion: present study indicated that the LBT group which received crude cocktail leishmania antigen plus alcoholic extract of Teucrium polium and BCG as adjuvant showed satisfactory cytokines profile comparing to groups LT and LB,since highest levels of IL12 and lower levels of IL10 which could help the infected subjects to inhibit or eradication the intracellular leishmania amastigotes, and also was seen highest increase in the spleen white-pulp size which pointed to the synergistic effects of alcoholic extract of T. polium and BCG.

Epidemiological, clinical and hematological profiles of visceral leishmaniasis among patients visiting Tefera Hailu Memorial Hospital, Northeast Ethiopia: a 4 year retrospective study

Visceral leishmaniasis is a major, life-threatening parasitic disease that still remains a serious public health problem in Ethiopia. Understanding the epidemiological, clinical, and hematological profiles of visceral leishmaniasis patients is important for implementing evidence-based control strategies. It is also important for early treatment and to decrease the mortality rate from the disease. Therefore, this study was aimed at assessing the epidemiological, clinical, and hematological profiles of visceral leishmaniasis among patients visiting Tefera Hailu Memorial Hospital, Northeast Ethiopia. A retrospective study was conducted at Tefera Hailu Memorial Hospital from September 2017 to August 2021. Data were collected from the medical records of suspected patients who were tested by the rK39 rapid diagnostic by strictly following standard operating procedures. The data was summarized using Microsoft Excel and analyzed using SPSS 26 version software. Descriptive statistics were used to describe the epidemiological, clinical, and hematological profiles of visceral leishmaniasis patients. A p-value < 0.05 was considered statistically significant. The overall positivity rate for visceral leishmaniasis was 23.4% (132/564). The result of this study indicated a fluctuating yet declining trend in VL over the past 4 years. From a total of 132 VL confirmed cases, the numbers of cases were highest among males (78.0%), those 15–29 years of age (37.1%), and urban residents (89.4%). Furthermore, Abergele (11.0%), Sehala (6.0%), and Ziquala (5.0%) districts had the highest number of VL cases. The major clinical presentations of patients were fever (96.2%), splenomegaly (94.7%), and general weakness (80.3%). With regard to hematological profiles, the most common findings were anemia (86.4%), thrombocytopenia (81.8%), leucopenia (78.8%), neutropenia (74.2%), and pancytopenia (71.2%). In the study area, the VL positivity rate was high. Our findings also concluded that VL causes significant alterations in clinical and hematological parameters. Therefore, the zone health office and other concerned stakeholders should strengthen evidence-based control programs for VL.

Spatial analysis of the risk for canine visceral leishmaniasis in an urban area in the State of Sergipe.

Visceral Leishmaniasis is included among the neglected tropical diseases, being directly related to conditions of social vulnerability, in urban environments, dogs act as important reservoirs. The aim of the study was to evaluate the distribution of dogs, related risk factors and identify of volatile organic compounds from infected dogs. Peripheral blood samples from 72 dogs were collected for detection using the ELISA test, in addition to hair samples for analysis by GC-MS. Of the evaluated dogs, 13 (18.05%/72) were reactive for canine VL, seven in Aracaju and six in Propriá. Factors related to vegetation, age, place where the dog stays and free access to the street, were associated with a greater chance of the dog becoming infected. Fifty-three compounds were identified from ten canine hair samples, among which 2-butoxyethanol, benzaldehyde, decane, 2-phenylacetaldehyde, nonan-1-ol, 2-phenoxyethanol, nonanoic acid, 8-heptadecene and eicosane were found in seropositive dogs for leishmaniasis. The guardian's posture has been increasingly important, requiring more attention to the dog's health and actions aimed at environmental management in an attempt to reduce cases of canine VL in the state. Even though the identified VOCs have not been associated with leishmanial infection, it is of great use for understanding canine hair substances.

Fatty Acid Transfer from Blood to Milk Is Disrupted in Mothers with Low Milk Production, Obesity, and Inflammation

Obesity is associated with chronic inflammation and is a risk factor for insufficient milk production. Inflammation-mediated suppression of LPL could inhibit mammary uptake of long-chain fatty acids (LCFAs; >16 carbons). In an ancillary case-control analysis, we investigated whether women with low milk production despite regular breast emptying have elevated inflammation and disrupted transfer of LCFAs from plasma into milk. Data and specimens from a low milk supply study and an exclusively breastfeeding control group were analyzed, with milk production measured by 24-h test-weighing at 2-10 wk postpartum. Low milk supply groups were defined as very low (VL; <300mL/d; n=23) or moderate (MOD; ≥300mL/d; n=20) milk production, and compared with controls (≥699mL/d; n=18). Serum and milk fatty acids (weight% of total) were measured by GC, serum and milk TNF-α by ELISA, and serum high-sensitivity C-reactive protein (hsCRP) by clinical analyzer. Group differences were assessed by linear regression models, chi-square exact tests, and Kruskal-Wallis nonparametric tests. VL cases, as compared with MOD cases and controls, had higher prevalence of elevated serum hsCRP (>5mg/L; 57%, 15%, and 22%, respectively; P=0.004), detectable milk TNF-α (67%, 32%, and 33%, respectively; P=0.04), and obesity (78%, 40%, and 22%, respectively; P=0.003). VL cases had lower mean±SD LCFAs in milk (60%±3%) than MOD cases (65%±4%) and controls (66%±5%) (P<0.001). Milk and serum LCFAs were strongly correlated in controls (r=0.82, P<0.001), but not in the MOD (r=0.25, P=0.30) or VL (r=0.20, P=0.41) groups (Pint<0.001). Mothers with very low milk production have significantly higher obesity and inflammatory biomarkers, lower LCFAs in milk, and disrupted association between plasma and milk LCFAs. These data support the hypothesis that inflammation disrupts normal mammary gland fatty acid uptake. Further research should address impacts of inflammation and obesity on mammary fatty acid uptake for milk production.

Epidemiological features and spatial-temporal clustering of visceral leishmaniasis in mainland China from 2019 to 2021.

BackgroundVisceral leishmaniasis (VL) is a serious vector-borne disease in central and western China. In recent years, the number of VL cases increased gradually, particularly the mountain-type zoonotic visceral leishmaniasis (MT-ZVL). This study clarified the epidemiological features and spatial-temporal clustering of VL in China between 2019 and 2021, identified the risk areas for VL transmission, and provided scientific evidence for the prevention and control of VL.Materials and methodsThe information on VL cases in 2019–2021 was collected from the Infectious Disease Reporting Information Management System of the Chinese Center for Disease Control and Prevention. The epidemiological characteristics of VL cases were analyzed. The global Moran’s I and Getis-ORD Gi* statistical data were processed for spatial autocorrelation and hotspot analysis in ESRI ArcGIS software. Also, spatial-temporal clustering analysis was conducted with the retrospective space–time permutation scan statistics.ResultsA total of 608 VL cases were reported from 2019 to 2021, with 158, 213, and 237 cases reported each year, respectively. Of the 608 cases, there were 10 cases of anthroponotic visceral leishmaniasis (AVL), 20 cases of desert-type zoonotic visceral leishmaniasis (DT-ZVL), and 578 cases of MT-ZVL. The age of VL cases was mainly distributed in the group of subjects aged ≥ 15 years. Peasants and infants were the dominant high-risk population. The incidence peak season of VL occurred between March and May. The cases were mainly distributed in Shanxi (299 cases), Shaanxi (118 cases), and Gansu (106 cases) Provinces, accounting for 86.02% (523/608) of the total reported cases in China. Spatial analysis revealed that clustering of infection is mainly located in eastern Shanxi Province and Shaanxi–Shanxi border areas, as well as southern Gansu and northern Sichuan Province. In addition, new reemergence hotspots in Shanxi, Henan, and Hebei Provinces have been detected since 2020. Spatio-temporal clustering analysis revealed an increase in the degree of infection aggregation in eastern Shanxi Province and Shaanxi–Shanxi border areas.ConclusionThe AVL and DT-ZVL were endemic at a lower level in western China, whereas MT-ZVL rebounded rapidly and showed a resurgence in historically endemic counties. The spatial-temporal clustering analysis displayed that the high-incidence areas of VL have shifted to central China, particularly in Shanxi and Shaanxi Provinces. Integrated mitigation strategies targeting high-risk populations are needed to control VL transmission in high-risk areas.

The increasing incidence of visceral leishmaniasis relapse in South Sudan: A retrospective analysis of field patient data from 2001-2018.

Visceral Leishmaniasis (VL) is endemic in South Sudan, manifesting periodically in major outbreaks. Provision of treatment during endemic periods and as an emergency response is impeded by instability and conflict. Médecins Sans Frontières (MSF) has provided health care in South Sudan since the late 1980's, including treatment for 67,000 VL patients. In recent years, MSF monitoring data have indicated increasing numbers of VL relapse cases. A retrospective analysis of these data was performed in order to provide insight into the possible causes of this increase. Programme monitoring data from the MSF hospital in Lankien, Jonglei State, South Sudan, for the period 2001-2018 were analysed to detect trends in VL relapse as a proportion of all VL cases presenting to MSF treatment centres. Routinely collected patient-level data from relapse and primary VL cases treated at all MSF sites in South Sudan over the same period were analysed to describe patient characteristics and treatments received. VL relapse as a proportion of all VL cases increased by 6.5% per annum (95% CI 0.3% to 13.0%, p = 0.04), from 5.2% during 2001-2003 to 14.4% during 2016-2018. Primary VL and VL relapse patients had similar age, sex and anthropometric characteristics, the latter indicating high indices of undernutrition which were relatively constant over time. Clinical factors (Hb, spleen size, and VL severity score) also did not vary substantially over time. SSG/PM was the main treatment regimen from 2001-2018, used in 68.7% of primary and 70.9% of relapse VL cases; AmBisome was introduced in 2013, received by 22.5% of primary VL and 32.6% of VL relapse cases from 2013-2018. Increasing incidence of VL relapse in South Sudan does not appear to be explained by changes in patient characteristics or other factors. Our data are concerning and may indicate an emergence of treatment-resistant parasite strains, decreasing the effectiveness of treatment regimens. This warrants further investigation as a causal factor. New chemical entities that will enable safe and highly effective short-course oral treatments for VL are urgently needed.

FATORES DE RISCO E SOROPREVALÊNCIA DE ASSINTOMÁTICOS DA LEISHMANIOSE VISCERAL HUMANA EM ÁREA DE TRANSMISSÃO INTENSA EM PETROLINA/PE, BRASIL

OBJECTIVES: To identify the seroprevalence of asymptomatic individuals in areas of disease transmission and analyze the environmental, socioeconomic and demographic risk factors in the municipality of Petrolina/PE, Brazil. METHODS: We approached 92 individuals in 19 localities with VL cases recorded in the Information System for Notifiable Diseases (SINAN) between 2016 and 2017. In each visit, two questionnaires were applied seeking to obtain clinical, social, economic and environmental variables. Viable blood samples collected during the visits (n=90) were submitted to the Indirect Immunofluorescence Reaction to identify anti-Leishmania antibodies. For data analysis, descriptive statistical tests were performed using Stata® 14.0 software. RESULTS: The presence of antibodies was detected in 2.2% (2/90) of the samples, in which one individual presented symptoms and the other was classified as asymptomatic. No risk factors related to the presence of anti-Leishmania antibodies were identified. CONCLUSION: The identification of one asymptomatic individual reinforces the importance of expanding human prevalence studies in endemic areas. Despite the low prevalence, it was possible to identify a possible case with manifestation of the clinical form of chronic VL that needs proper care.

Visceral Leishmaniasis in Ardabil Province, Northwest of Iran: A Retrospective Epidemiological, Clinical and Paraclinical Study (1985-2018).

Background:We aimed to investigate the epidemiological, clinical and paraclinical aspects of Visceral Leishmaniasis in Ardabil Province, from 1986 to 2018.Methods:The disease has been diagnosed by a serological validate test as Direct Agglutination Test, parasitological methods, and clinical manifestations. The data were collected and then analyzed.Results:Overall, 2824 out of 69007cases (4.1%) had anti-Leishmania antibodies at titers≥1:3200. The majority of VL cases belonged to Meshkin-Shahr, and then Germi County. The percentages of both male and female cases were 52.8 % and 46.6%, respectively. Approximately 78.1% of cases were less than 5 yr old. The high incidence rate of the disease was recorded in the years 1987 and 2003. 48.6%, 3.2%, and 1.9% of the patients had low titer (1:3200), high titer (1:102400), and suspicious titer (1:1600), respectively. Out of 1200 bone marrow aspiration, 23% were positive, and 77% were negative. Fever, paleness, and hepatosplenomegaly were the main symptoms in patients. Moreover, abdominal swelling, edema, weight loss, lymphadenopathy and jaundice were some other symptoms in the patients. Among biochemistry factors, the levels of aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, triglyceride and cholesterol have been increased. The death rate was estimated to be 2.8%, mainly related to the Ardabil and Germi cases.Conclusion:Kala-Azar is still one of the most important infectious diseases in Ardabil Province, and is responsible for considerable death rate in infants. More attention should be done to parasite control and early diagnosis.

Investigation of Visceral LeishmaniasisTransmission in Selected Districts of Nepal.

Visceral leishmaniasis is transmitted to humans by Leishmania donovani infected Phlebotomus argentipes sandflies. Nepal has successfully met the elimination target of less than 1 case per 10,000, although recently this threshold has been surpassed demonstrating ongoing transmission. The main objective of the present study was to investigate transmission of visceral leishmaniasis in 4 visceral leishmaniasis endemic districts of Nepal including Palpa, Morang, Saptari and Sarlahi. Human blood samples (331), domestic animals blood samples [goats (n=67), dogs (n=1), cows (n=6), buffaloes (n=16), and ox (n=10)] and sandflies samples (3976 from 142 households) were collected from the villages of these 4 districts. Human blood samples were tested for VL antibodies using the rK39 rapid diagnostic test (InBios International, Seattle, WA). kDNA of L.donovani was amplified by PCR from DNA extracted from human blood, animal blood and sandfly samples. Out of 331 screened across 4 districts,32 were positive on rK39 serology and 16 were positive by PCR amplification of kDNA from L. donovani. The majority of the positive serology and PCR tests were from the Ishworpur village in the Sarlahi district where there was an outbreak of 18 cases of VL. This study also revealed the presence of L. donovani DNA in female P. argentipes sandflies collected from the Ishworpur village of Sarlahi, 6 villages in the Saptari,10 villages in the Palpa, and from 9 villages in the Morang. Blood samples from domestic animals in the same villages were negative for kDNA detection by PCR. The results of human and sandfly findings strongly point towards local transmission of visceral leishmaniasis in these 4 districts of Nepal. Notably, there is a significant level of transmission in the Ishworpur village in the Sarlahi district. The observations from this study suggest that domestic animals are not a reservoir host forL. donovaniin these districts in Nepal. Ongoing surveillance is needed to identify new outbreaks such as in the Sarlahi district.

Leishmaniasis: Plants as a source of antileishmanial agents

Leishmania infection causes a group of tropical diseases and has remained neglected for decades. It spreads by sandfly vector and is one of the most fatal protozoan diseases after malaria. Leishmaniases are a group of diseases caused by the infection of different Leishmania species and display clinically different forms like “Visceral leishmaniasis” (VL), “mucocutaneous leishmaniasis” and “cutaneous leishmaniasis” (CL). Approximately one billion people living in an endemic area are at high risk. Three hundred thousand cases of VL are reported annually and around twenty thousand people die every year, proving it as one of the most lethal forms of leishmaniasis. Until now, no effective vaccine could be made. There is an increase in drug resistance in the case of conventional drugs. New synthetic drugs are either too costly or have side effects. Requirements of new drugs are of utmost importance to control this situation. Plants provide a source of unlimited chemical diversity, which can be screened for antileishmanial activities. Moreover, their low cost and less or no side effects make them idle candidates in the search of new antileishmanial drugs.

Strengthening Visceral Leishmaniasis Diagnosis Capacity to Improve Access to Care in Kenya: The Example of Marsabit County

BackgroundVisceral leishmaniasis (VL), also known as kala-azar, is a neglected tropical disease (NTD) that is fatal if not treated early. The WHO targets the elimination of VL as a public health problem in its 2030 NTD road map. However, improving access to VL diagnosis and treatment remains a major challenge in many VL-endemic countries. Kenya is endemic for VL and is among the top 6 high-disease burden countries in the world.MethodsFIND, through its activities in improving the diagnosis of VL and supporting the elimination of the disease in Kenya, has worked with various county ministries of health (MOH) and central MOH over the last couple of years. FIND’s activities in Marsabit county started in 2018. In this work, we present the implementation of activities and the impacts in Marsabit county. We reviewed the data for 2017 and 2019 outbreaks (before and after the implementation of FIND’s activities) and assessed the importance of improving access and community sensitization to VL diagnosis. We assessed the contribution of each facility to the total distance traveled from a perspective of location optimization.ResultsThere was a sharp increase in the number of people tested in the 2017 outbreak compared to the 2019 outbreak. In 2017, 437 people were tested compared to 2,338 in 2019. The county reported 234 and 688 VL cases in 2017 and 2019, respectively. The data revealed a shift in the demographic structures of cases toward the younger population (mean age in 2017 was 17.6 years and 15.3 years in 2019), with more female cases reported in 2019 compared to 2017. In 2017, 44.4% were 10 years of age or under. In 2019, the proportion 10 years or below was 52.2%. The addition of two new diagnosis facilities in 2018 resulted in a decrease in the distance traveled by confirmed VL cases from 28.1 km in 2017 to 10.8 km in 2019. Assessing the impact of facility placement indicated the most optimal facilities to provide VL diagnostic services and minimize the distance traveled by patients. Adding new facilities reduces the travel distance until a point where the addition of a new facility provides no additional impact.ConclusionThe results from this study indicate the need to carefully consider the placement of health facilities in improving access to VL diagnosis and treatment and could serve as an investment case in deciding when to stop adding new facilities in a particular setting. Extending the activities in Kenya to other VL-endemic countries in East Africa will contribute significantly toward the elimination of the disease, addressing the needs of marginalized populations and leaving no one behind.