Clinical Review

Leishmaniasis: new approaches to disease control

BMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7385.377 (Published 15 February 2003) Cite this as: BMJ 2003;326:377
  1. Clive R Davies (clive.davies@lshtm.ac.uk), head of disease control and vector biology unita,
  2. Paul Kaye, professor of cellular immunologya,
  3. Simon L Croft, reader in parasitologya,
  4. Shyam Sundar, head of departmentb
  1. a Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT,
  2. b Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, India
  1. Correspondence to: C R Davies

    Leishmaniasis is one of the major infectious diseases affecting the poorest regions of the world, but new developments in diagnosis, treatment, and control offer some fresh hope

    The leishmaniases afflict the world's poorest populations. Among the two million new cases each year in the 88 countries where the disease is endemic (fig 1), it is estimated that 80% earn less than $2 a day. Human infections with Leishmania protozoan parasites, transmitted via the bite of a sandfly, cause visceral, cutaneous, or mucocutaneous leishmaniasis. The global burden of leishmaniasis has remained stable for some years, causing 2.4 million disability adjusted life years (DALYs) lost and 59 000 deaths in 2001.1 Neglected by researchers and funding agencies, leishmaniasis control strategies have varied little for decades, but in recent years there have been exciting advances in diagnosis, treatment, and prevention. These include an immunochromatographic dipstick for diagnosing visceral leishmaniasis; the licensing of miltefosine, the first oral drug for visceral leishmaniasis; and evidence that the incidence of zoonotic visceral leishmaniasis in children can be reduced by providing dogs with deltamethrin collars. There is also hope that the first leishmaniasis vaccine will become available within a decade. Here we review these developments and identify priorities for research.

    Summary points

    Simple and rapid diagnostic tools for leishmaniasis will soon be widely available

    A new range of affordable and effective treatments, including oral drugs, are coming on line

    The development of drug resistance is a major concern and needs strategic plans

    New methods of applying insecticides for preventing leishmaniasis are likely to take the place of house spraying and (for zoonotic visceral leishmaniasis) dog culling

    Strategies need to be developed to optimise progression of vaccine candidates to phase I trials

    Current research effort and resources should prioritise visceral leishmaniasis in the Sudan and Indian subcontinent, where the burden …

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