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Indian visceral leishmaniasis (VL) is a parasitic disease caused by a haemoflagellete Leishmania donovani and transmitted by the bite of sand fly Phlebotomus argentipes. It affects various age groups. In India about 1,00,000 cases of VL are estimated to occur annually; of these, the State of Bihar accounts for over than 90 per cent of the cases. Diagnosis of VL typically relies on microscopic examination of tissue smears but serology and molecular methods are better alternatives currently. Notwithstanding the growing incidence of resistance, pentavalent antimony complex has been the mainstay for the treatment of VL during the last several decades. The second line drugs such as amphotericin B, lipid formulations of amphotericin B, paromomycin and recently developed miltefosine are the other alternatives. In spite of significant development in various areas of Leishmania research, there is a pressing need for the technological advancement in the understanding of immune response, drug resistance and the pathogenesis of leishmaniasis that could be translated into field applicable and affordable methods for diagnosis, treatment, and control of the disease.
Key words Control measures - diagnosis - drug resistant - treatment - visceral leishmaniasis
Leishmaniasis, caused by 20 species of Leishmania and transmitted by 30 species of sand fly, is characterized by diversity and complexity1-4. Most of Leishmania infections are zoonotic and rodents and canids are reservoir host. Only two Leishmania species can maintain anthroponotic, human-human cycle, these species are L. donovani responsible for visceral leishmaniasis (VL) in Indian subcontinent and east Africa and L. tropica, which is responsible for cutaneous leishmaniasis (CL) in the Old World5. Female sand fly of genus Phlebotomus in the Old World and Lutzomyia in the New World are the only proven vector responsible for transmission of the disease6. In India, Phlebotomus argentipes is the only proven vector for the disease.
Leishmaniasis has been considered a tropical affliction that constitutes one of the six entities on the World Health Organization tropical disease research (WHO TDR) list of most important diseases7. It occurs in 88 countries in tropical and temperate regions, 72 of them developing or least developed. An estimated 350 millions population is at risk and 10 million people are affected from this disease worldwide1. Two million cases occur annually however, there is a gross...