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Leishmaniasis, a globally prevalent parasitic disease occurs in three forms viz., visceral, cutaneous and mucocutaneous, transmitted by the bite of infected female Phlebotomus sandflies. Visceral leishmaniasis (VL) has 100 per cent fatality rate, if left untreated. India has the largest burden of this disease. HIV infection is also increasing worldwide and several reports indicate rising trend of VL/ HIV co-infection, modifying the traditional anthroponotic pattern of VL transmission. Both VL and HIV tend to lower the cell mediated immunity (CMI) resulting in poor drug response and opportunistic infections involving gastrointestinal, cutaneous, respiratory tract and central nervous system (CNS) may occur. Diagnosis of such co-infected cases is quite difficult. However, newer tests like nested PCR, rk39 immunochromatographic test etc., can be of help. Response to different antileishmanial drugs like sodium antimony gluconate (SAG), amphotericin B is far from satisfactory. However, a new oral drug miltefosine has been found to be promising. Highly active antiretroviral therapy (HAART) need to be given for management of HIV infection along with treatment of other opportunistic infections.
Key words Co-infection * HIV * Leishmania * opportunistic infections
The leishmaniases is a group of insecttransmitted parasitic diseases which are most misunderstood and least studied of endemic diseases. Three parasitic varieties are the primary culprits: Leishmania donovani causing visceral leishmaniasis (VL), Leishmania tropica causing cutaneous leishmanisis (CL) and Leishmania braziliensis causing mucocutaneous leishmaniasis (ML). The disease is prevalent worldwide, considered to be endemic in 88 countries: 72 of which are developing countries and 13 are among the least developed countries. It is believed that 350 million people are at risk, and 12 million people are affected by leishmaniasis worldwide. Of this, 1.5-2 million new cases are estimated to occur annually of which only 600,000 cases are officially reported1-3.
It is estimated that of the 600,000 new cases of VL that occur annually, 90 per cent of these occur in five countries, viz., Bangladesh, Brazil, India, Nepal and Sudan (WHO Fact Sheet No. 116, Rev. May 200O)4. Three types of VL are recognized worldwide namely African kala-azar, mediterranean or infantile kala-azar and Indian kala-azar. African kala-azar, generally affecting older children and young adults, is found in eastern half of Africa from the Sahara in the north to the equator. Mediterranean or infantile...