Clinical Review

Science, medicine, and the future: Leishmaniasis

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7264.801 (Published 30 September 2000) Cite this as: BMJ 2000;321:801
  1. Lynden J Roberts, research student,
  2. Emanuela Handman, head, leishmania laboratory,
  3. Simon J Foote, cohead, genetics and bioinformatics division ([email protected])
  1. Walter and Eliza Hall Institute of Medical Research, Post Office Royal Melbourne Hospital, Victoria 3050, Australia
  1. Correspondence to: S J Foote

    Leishmaniasis constitutes a diverse collection of human diseases ranging in severity from a spontaneously healing skin ulcer to overwhelming visceral disease. Worldwide, two million new cases occur each year, and a 10th of the world's population is at risk of infection.1 Although the disease is highly endemic throughout northern Africa, the Middle East, parts of Europe, and Central and South America, epidemics are well recognised. For example, in southern Sudan more than 10% of the population died from visceral leishmaniasis over the past five years.

    Outcome of infection is determined by interactions between the host and parasite, which are governed by the genomes of the host and parasite. It is therefore exciting to see that both host and parasite genomes have been targeted for sequence analysis.2 The leishmania genome project began as a large scale attempt to sequence part of each of the transcripts of all the genes of the organism, and the plan is now to sequence its entire genome. The genetic information from both human and parasite and the emergence of new tools such as microarray technologies will allow us to gain an understanding of the interaction between parasite virulence factors and host response factors. Molecular knowledge of the host-parasite interaction will facilitate targeting of new treatments.

    Methods

    We chose topics for this article to convey the impact that current research will have on the pathophysiology and treatment of leishmaniasis. We used a variety of sources for the topics, including published original articles and reviews, the internet, and personal communications.

    Background

    Epidemiology

    Leishmaniasis results from an infection with the protozoan parasite Leishmania spp. The organism is transmitted to humans by the bite of the sandfly.1 Humans are usually accidental hosts of these 2 mm long flies; natural hosts include a variety of rodents, small mammals, and dogs. Disease …

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