Leishmaniasis: current situation and new perspectives

• Published in: Comparative immunology, microbiology and infectious diseases microbiology and infectious diseases, 2004-09, Vol.27 (5), p.305-318
• Main Author: Desjeux, P
• Format: Article
• Language: English
• Subjects: Animals; Antiprotozoal Agents - economics; Antiprotozoal Agents - therapeutic use; Burden; Charge; Cutaneous; Cutanée; Diptera - parasitology; Facteurs de risque; Female; Human immunodeficiency virus; Humans; Incidence; Insect Vectors - parasitology; Leishmania - growth & development; Leishmaniasis; Leishmaniasis, Cutaneous - drug therapy; Leishmaniasis, Cutaneous - economics; Leishmaniasis, Cutaneous - epidemiology; Leishmaniasis, Visceral - drug therapy; Leishmaniasis, Visceral - economics; Leishmaniasis, Visceral - epidemiology; Leishmaniose; Male; Outils pour la lutte; Prevalence; Public health; Recherche; Risk factors; Santé publique; Tools for control; Visceral; Viscérale; World Health Organization
• ISSN: 0147-9571; 1878-1667
• DOI: 10.1016/j.cimid.2004.03.004

Leishmaniasis represents a complex of diseases with an important clinical and epidemiological diversity. Visceral leishmaniasis (VL) is of higher priority than cutaneous leishmaniasis (CL) as it is a fatal disease in the absence of treatment. Anthroponotic VL foci are of special concern as they are at the origin of frequent and deathly epidemics (e.g. Sudan). Leishmaniasis burden remains important: 88 countries, 350 million people at risk, 500,000 new cases of VL per year, 1–1.5 million for CL and DALYs: 2.4 millions. Most of the burden is concentrated on few countries which allows clear geographic priorities. Leishmaniasis is still an important public health problem due to not only environmental risk factors such as massive migrations, urbanisation, deforestation, new irrigation schemes, but also to individual risk factors: HIV, malnutrition, genetic, etc… Leishmaniasis is part of those diseases which still requires improved control tools. Consequently WHO/TDR research for leishmaniasis has been more and more focusing on the development of new tools such as diagnostic tests, drugs and vaccines. The ongoing effort has already produced significant results. The newly available control tools should allow a scaling up of control activities in priority areas. In anthroponotic foci, the feasibility of getting a strong impact on mortality, morbidity and transmission, is high. Les leishmanioses représentent un groupe de maladies extrémement diverses tant sur le plan clinique qu'épidémiologique. La leishmaniose viscérale (LV) mérite une attention toute particulière car mortelle en l'absence de traitement. En ce qui concerne la lutte, il convient de s'attaquer prioritairement aux foyers de leishmaniose viscérale anthroponotique, sources d'épidémies fréquentes et mortelles (Soudan). Le poids de la maladie reste considérable: 88 pays, 350 millions de personnes à risque, une incidence annuelle pour la leishmaniose viscérale de 500.000 cas et pour la cutanée de 1 à 1,5 million et enfin des DALYs estimés à 2,4 millions. La majorité des cas se concentrent sur quelques pays. Ce qui facilite la définition de priorités géographiques. La leishmaniose reste un sévère problème de santé publique du fait de l'importance ccroissante des risques liés à l'environnement tels que les migrations, l'urbanisation, la déforestation, les nouveaux schémas d'irrigation mais aussi des risques individuels comme le VIH, la malnutrition et les facteurs génétiques. La leishmaniose fait partie des