Conference abstract

Visceral leishmaniasis: clinical and therapeutic aspects

Pan African Medical Journal - Conference Proceedings. 2017:4(19).15 Dec 2017.
doi: 10.11604/pamj-cp.2017.4.19.397

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Keywords: Visceral leishmaniasis, Kala-azar, diagnosis, treatment
Abstract

Visceral leishmaniasis: clinical and therapeutic aspects

Imen Chabchoub1,&

1Pediatric unit, Hedi Chaker Hospital, Sfax, Tunisia

&Corresponding author
Imen Chabchoub, Pediatric unit, Hedi Chaker Hospital, Sfax, Tunisia

Abstract

Introduction: visceral leishmaniasis (VL) is endemic in areas bordering the Mediterranean Sea, including Tunisia. It represents a major public health problem not only in developing countries but also in developed ones. It is caused by Leishmania infantum and it is transmitted by the bite of hematophagous sand fly belonging to phlebotomus spp; dog constitutes the main reservoir of the infection.

Methods: systemic review of the national and international medical literature concerning this disease.

Results: clinical presentation of VL ranges from asymptomatic or subclinical infection to severe and complicated symptomatic disease. Classical manifestations of visceral leishmaniasis include chronic fever, pallor and splenomegaly. Pancytopenia is present very often. Rarely, it may be complicated by hemophagocytic lymphohistiocytosis (HLH) that has varied presentation and course. Diagnosis is established by serological tests (indirect fluorescent-antibody assay, immunoassay test, indirect hemagglutination assay) and by demonstration of Leishmania parasites by microscopy or polymerase chain reaction (PCR) in the bone marrow aspirates. Visceral Leishmaniasis is fatal if left untreated. Although pentavalent antimonial drugs have been used for many decades as standard treatment for VL, newer therapeutic options are nowadays considered the first-line treatment in many countries. They include conventional or liposomal amphotericin B, paromomycin and miltefosine. Liposomal amphotericin B seems to be the most tolerated drug. Unfortunately, it is not available in Tunisia. Recently, an international scientific seminar has been held in Pasteur institute of Tunis from the 2nd- 4th April 2015, about visceral leishmaniasis in Maghreb. Three recommendations have been considered by the experts attending this international scientific seminar. Firstly, the necessity to decrease the delay between onset of symptoms and getting a proper diagnosis This aim can be reached by: the training of medical and nursing staff and education of high risk population, the use of rapid diagnostic tests in area with a high incidence of VL, the use of real time PCR on blood samples for diagnosis of VL to avoid marrow aspiration. Secondly, the usefulness of liposomal amphotericin as first-line therapeutic option in management of visceral leishmaniasis. The experts participating in the international scientific seminar agreed on the need to replace the meglumine antimoniate by liposomal amphotericin as first-line therapeutic option in Maghreb countries. This new drug will shorten considerably the duration of therapeutic cures and improve the effectiveness of the treatment and its safety. For immunocompromised patients (HIV (+), Infection and Solid Organ Transplant Recipients), it was strongly recommended to implement a post treatment long term follow-up because of the risk of relapse. And thirdly, the urgent need of fighting against the zoonosis by the control of reservoir host (dog) and the vector (sandflies). The actions include: the eradication of stray and semi-stray dogs, the early detection of canine leishmaniasis, the prevention of canine leishmaniasis (insecticide-impregnated dog collars), the setting up of clean environment (garbage control, whitewashing the walls, nets).

Conclusion: despite many previous studies realized on Leishmaniases in Maghreb, they are still considered as neglected diseases because of absence of efficient control strategies. Poor vector control strategies, limited diagnostic services, drugs, treatments and lack of community awareness are the most important challenges in VL control and elimination especially in endemic areas such as Tunisia. Absence of highly sensitive and specific tests, lack of trained man power, and community awareness are the major challenges in VL control. Therefore, proper case diagnosis, community mobilization and launching of effective vector control strategies in our country are vital.