Visceral Leishmaniasis at the National Reference University Hospital Center of N’Djamena (Chad): Epidemiological, Clinical, Diagnostic, Therapeutic and Prognostic Aspects

Introduction: leishmaniasis is a group of parasitic diseases caused by a parasite of the genus Leishmania transmitted by the bite of an infected vector called a sandfly. There are four forms. Visceral leishmaniasis is the most severe form. The aim of our work is to study the epidemiological, clinical, diagnostic, therapeutic and prognostic aspects of the disease in the Infectious Diseases Department of the Centre Hospitalier Universitaire de Référence Nationale in N'Djaména. Methodology: Patients were recruited on the basis of clinical signs suggestive of visceral leishmaniasis, i.e. prolonged fever, splenomegaly and altered general condition. Biological confirmation was performed with a rapid diagnostic test using recombinant K39 parasite antigen, which is known to have good specificity and sensitivity. Epidata version 3.1 software was used to process patient data. Results: From 05/04/21 to 15/12/23, 153 positive cases were managed. The mean age of patients was 18 years, with a sex ratio of 9.2. Of these patients, 103 (67.3%) had recently stayed at gold mining sites. Patients testing positive were treated with sodium stibogluconate combined with paromomycin for 17 days. The mortality rate was 13.2%. Conclusion: Leishmaniasis is a serious and little-known disease in Chad. In order to respond to the disease, it is necessary to reinforce the capacities of health structures and to carry out appropriate actions in the outbreaks.

Liposomal dual delivery systems in visceral leishmaniasis enhance the synergistic effects of combination therapy:A promise for the future

Visceral leishmaniasis(VL)is a neglected tropical disease,and this review has summarized the current treatment scenario and its prospects.It also highlights alternative approaches used by research groups in India and around the world to develop cutting-edge and potent anti-leishmanial treatments.Even though numerous medications could be utilized to treat VL,the limitations of current treatments including their toxicity,cost,route of administration,and duration of doses,have contributed to the emergence of resistance.Combination therapy might be a better option due to its shorter duration,easier route of administration,and ability to extend the lifespan of individual drugs.However,there is a risk of not delivering both the drugs to the target site together,which can be overcome by the liposomal entrapment of those drugs and at a time knock an opportunity to reduce the dosage of amphotericin B if the combination drug provides a synergistic effect with it.Therefore,this review presents a novel strategy to fight against VL by introducing dual drug-loaded liposomes.

American tegumentary leishmaniasis mimicking myiasis and granulomatous vasculitis:A case report

Rationale:American tegumentary leishmaniasis comprises cutaneous and mucocutaneous manifestations caused by parasitic infections by various Leishmania species.This report details the clinical interventions for a patient with American tegumentary leishmaniasis in Mendoza,Argentina,a non-endemic region.Patient concerns:A 43-year-old male was admitted to a tertiary care hospital in Mendoza,Argentina Republic with a history of progressive nasal discharge,septal perforation,facial pain,and pruritus.Despite treatment for presumed nasal myiasis and vasculitis with granulomatosis,symptoms persisted.Diagnosis:American tegumentary leishmaniasis.Interventions:Intravenous liposomal amphotericin B.Outcomes:Follow-up at 30 days showed no recurrence of symptoms with a remarkable clinical improvement of the nasal lesion.Lessons:This case sheds light on the necessity of accurate identification for timely intervention and the need to recognize the diverse manifestations of American tegumentary leishmaniasis to avoid misdiagnosis.

Hematological picture of pediatric Sudanese patients with visceral leishmaniasis and prediction of leishmania donovani parasite load

BACKGROUND Visceral leishmaniasis(VL)is a systemic protozoan infection caused by Leishmania donovani(L.donovani)and transmitted by sand flies,causing macrophage invasion in the liver,spleen,and bone marrow.Diagnosis of VL is currently based on clinical signs,symptoms,and specific in-vitro markers and bone marrow investigations.However,VL's specific hematological and bone marrow manifestation in Sudanese pediatric patients is not well studied.AIM To examine the blood and bone marrow characteristics in pediatric patients from Sudan who have VL.METHODS This is a retrospective hospital-based study with a sample of 107 consecutive Sudanese pediatric patients.The data focused on hematological and bone marrow results.We included only the completed records of the pediatric patients with VL in the Tropical Disease Teaching Hospital in Khartoum,Sudan from the period of 2016 to 2020.RESULTS The majority of pediatric patients included in this study are below 5-years-old(n=59,55.2%).Moreover,anemia,thrombocytopenia,and leukopenia were among the prevalent characteristics in the population under study.To further analyze the data,we developed a machine learning model using boosted forest algorithms to predict L.donovani parasites load,with a mean accuracy of 0.88 for the training dataset and an accuracy of 0.46,0.50,and 0.74 for mild,moderate,and severe L.donovani parasite load in the validation dataset.CONCLUSION This study shows that the most common bone marrow change among Sudanese VL children was increased chronic inflammatory cells(n=88,82.2%)with present macrophage hemophagocytes(n=103,96.3%).While anemia and thrombocytopenia were the most common hematological changes.These results will hopefully lead to an early diagnosis and hence better management for Sudanese pediatric patients with suspected VL.

Therapeutic response and safety of different treatments for cutaneous leishmaniasis in patients: A retrospective cross-sectional study

Objective:To analyze the therapeutic response and safety of different treatments for cutaneous leishmaniasis,received by patients in the Program for the Study and Control of Tropical Diseases-PECET-Medellín-Colombia.Methods:This is a retrospective cross-sectional study of patients attended at PECET Research Center during 2016-2021.Relevant information regarding sociodemographic characteristics,history of leishmaniasis,characterization of current infection,treatment received,follow-up of therapeutic response and safety was collected from the medical records.Data were analyzed with Pearson's Chi-square association tests and Mann-Whitney U test using statistical software.Results:A total of 486 clinical records of patients were analyzed,and 356 received treatment.Eight different therapeutic alternatives(systemic,local and in combination)were analyzed.The therapeutic response of the different alternatives used(except thermotherapy)was higher than 50%.Most frequent adverse events were myalgias,arthralgias and headache,and vesicles for systemic and local treatment,respectively.Conclusions:Safety profile and performance of local therapeutic alternatives and combined schemes for the treatment of uncomplicated cutaneous leishmaniasis are an interesting option for the management of the disease.

Jaundice in pediatric visceral leishmaniasis (kala-azar) patients

Objective:Visceral leishmaniasis(Kala-azar) is endemic in many countries including Bangladesh.Clinical presentation of visceral leishmaniasis in children and adult may vary and at time may simulate many tropical and hepatobiliary diseases.Jaundice and ascites are not common in kala-azar patients.Methods:During the period of January 2005 to December 2006,all the records of the confirmed kala-azar patients presented with jaundice were included in this study.Kala-azar was confirmed by serology test ICT(Immuno Chromatography) and Bone Marrow study.Results:Total 12 kala-azar patients were encountered during this period.Among these twelve cases,presenting features were jaundice(7),splenomegaly(12),hepatomegaly(11) and ascites (4).Initial clinical diagnosis of chronic liver disease(CLD) was made in(5),Congenital hemolytic anaemia in(1) and kala-azar in rest of the patients(6 ).Common leucopenia and relative lymphocytosis was not observed in any patients.Conclusion:Kala-azar may present with various clinical manifestation in children and adult.Jaundice can be considered to be a common manifestation particularly in pediatric kala-azar patients.Otherwise,it may mislead to another diagnosis if it is taken as a rare feature in kala-azar.

Worldwide risk factors in leishmaniasis

Recently, Vector-borne parasitic diseases such as leishmaniasis have been emerged or reemerged in many geographical areas and resulted in global health and economic concerns that involve humans, domestic animals and wild life. The ecology and epidemiology of leishmaniasis are affected by the between host, reservoir and vector(human, animal and sandfly) and the environment. Important drivers for the emergence and spread of leishmaniasis include environmental factors such as alterations in temperature and water storage, irrigation habits, deforestation, climate changes, immunosuppression by HIV or organ transplant, development of drug resistance, increase traveling to endemic regions and dog importation. War, poor socio-economic status and low level household are also major contributors to the spread of this disease. Health education via the public media and training should be implemented by international organizations and governmental agencies in collaboration with research institutions. During transmission season, fully protection can be mentioned by using bednets and insecticides and reservoirs' control in the planning. Based on the findings of the recent studies and high prevalence of leishmaniasis, it is concluded that serious public health monitoring should be considered.

Leishmaniasis:Current status of available drugs and new potential drug targets

The control of Leishmania infection relies primarily on chemotherapy till date.Resistance to pentavalent antimonials,which have been the recommended drugs to treat cutaneous and visceral leishmaniasis,is now widespread in Indian subcontinents.New drug formulations like amphotericin B,its lipid formulations,and miltefosine have shown great efGcacy to treat leishmaniasis but their high cost and therapeutic complications limit their usefulness.In addition, irregular and inappropriate uses of these second line drugs in endemic regions like state of Bihar, India threaten resistance development in the parasite.In context to the limited drug options and unavailability of either preventive or prophylactic candidates,there is a pressing need to develop true antileishmanial drugs to reduce the disease burden of this debilitating endemic disease.Notwithstanding significant progress of leishmanial research during last few decades, identification and characterization of novel drugs and drug targets are far from satisfactory.This review will initially describe current drug regimens and later will provide an overview on few important biochemical and enzymatic machineries that could be utilized as putative drug targets for generation of true antileishmanial drugs.

Forecasting the number of zoonotic cutaneous leishmaniasis cases in south of Fars province, Iran using seasonal ARIMA time series method

Objective: To predict the trend of cutaneous leishmaniasis and assess the relationship between the disease trend and weather variables in south of Fars province using Seasonal Autoregressive Integrated Moving Average(SARIMA) model,Methods: The trend of cutaneous leishmaniasis was predicted using Mini tab software and SARIMA model,Besides,information about the disease and weather conditions was collected monthly based on time series design during January 2010 to March 2016,Moreover,various SARIMA models were assessed and the best one was selected,Then,the model's fitness was evaluated based on normality of the residuals' distribution,correspondence between the fitted and real amounts,and calculation of Akaike Information Criteria(AIC) and Bayesian Information Criteria(BIC),Results: The study results indicated that SARIMA model(4,1,4)(0,1,0)(12) in general and SARIMA model(4,1,4)(0,1,1)(12) in below and above 15 years age groups could appropriately predict the disease trend in the study area,Moreover,temperature with a three-month delay(lag3) increased the disease trend,rainfall with a four-month delay(lag4) decreased the disease trend,and rainfall with a nine-month delay(lag9) increased the disease trend,Conclusions: Based on the results,leishmaniasis follows a descending trend in the study area in case drought condition continues,SARIMA models can suitably measure the disease trend,and the disease follows a seasonal trend.

Cutaneous leishmaniasis in Iran: Results from an epidemiological study in urban and rural provinces

Objective: To examine the prevalence and clinical manifestations of cutaneous leishmaniasis(CL) in Iran.Methods: This study was conducted in Iran between 2011 and 2013. Sampling, preparing, developing, and fixing of suspicious skin lesions were completed in healthcare centers in 31 Iranian provinces as well as in the Academic Reference Laboratory and the National Reference Laboratory. The information was then analyzed at the Ministry of Health's Information Management Center of Contagious Diseases.Results: Over a three-year period, the number of people identified with CL was 56 546.The highest incidence was reported in 2011(27.5 per 100 000). Wet CL accounted for 43.7% of cases while 43.3% resulted from sporotrichoid leishmaniasis. The results showed that there was a higher incidence of CL due to Leishmania major(50.2%) than to Leishmania tropica. The results of this study found that the highest incidence of CL had happened respectively in Ilam, Fars and, Khorasan Razavi Provinces between 2011 and 2013.Conclusions: Although the incidence of the disease is declining, CL is still a public health concern and disease control protocols need to be established. Therefore, further studies are needed to identify the vectors, reservoirs, and disease species as well as to develop appropriate disease control strategies.

Phlebotomus papatasi and Meriones libycus as the vector and reservoir host of cutaneous leishmaniasis in Qomrood District,Qom Province,central Iran

Objective:To determine the sand flies species responsible for most transmission of Leishmania major(L major) to human,as well as to determine the main reservoir hosts of the disease. Methods:Sand flies were collected using sticky papers and mounted in Puri’s medium for species identification.Rodents were trapped by live Sherman traps.Both sand flies and rodents were subjected to molecular methods for detection of leishmanial parasite.Results:Phlebotomus papatasi(P.papatasi) was the common species in outdoor and indoor resting places.Employing PCR technique only three specimens of 150 P.papatasi(2%) were found naturally infected by parasites with a band of 350 bp which is equal to the L major parasite.Forty six rodents were captured by Sherman traps and identified.Microscopic investigation on blood smear of the animals for amastigote parasites revealed 1(3.22%) infected Meriones libycus(M.libycus). Infection of this animal to L.major was confirmed by PCR against rDNA loci of the parasite. Conclusions:This is the first molecular report of parasite infection of both vector(P.papatasi) and reservoir(M.libycus) to L major in the region.The results indicated that P.papatasi was the primary vector of the disease and circulating the parasite between human and reservoirs and M. libycus was the most important host reservoir for maintenance of the parasite source in the area.

Next-generation sequencing technology for diagnosis and efficacy evaluation of a patient with visceral leishmaniasis: A case report

BACKGROUND Visceral leishmaniasis(VL)is a parasitic disease caused by Leishmania and transmitted by infected sand flies.VL has a low incidence in China,and its clinical presentation is complex and atypical.This disease is easily misdiagnosed and can become life-threatening within a short period of time.Therefore,early,rapid and accurate diagnosis and treatment of the disease are essential.CASE SUMMARY A 25-year-old male patient presented with the clinical manifestations of irregular fever,hepatosplenomegaly,increased polyclonal globulin,and pancytopenia.The first bone marrow puncture biopsy did not provide a clear diagnosis.In order to relieve the pressure and discomfort of the organs caused by the enlarged spleen and to confirm the diagnosis,splenectomy was performed,and hemophagocytic syndrome was diagnosed by pathological examination of the spleen biopsy.Following bone marrow and spleen pathological re-diagnosis and metagenomic next-generation sequencing(mNGS)technology detection,the patient was finally diagnosed with VL.After treatment with liposomal amphotericin B,the body temperature quickly returned to normal and the hemocytes recovered gradually.Post-treatment re-examination of the bone marrow puncture and mNGS data showed that Leishmania was not detected.CONCLUSION As a fast and accurate detection method,mNGS can diagnose and evaluate the efficacy of treatment in suspicious cases of leishmaniasis.

Knowledge,attitude,and practices related to cutaneous leishmaniasis in an endemic focus of cutaneous leishmaniasis,Southern Iran

Objective:To assess knowledge,attitudes,and practices(KAP)of inhabitants of an endemic area it)Fars province toward cutaneous leishmaniasis(CI).Methods:the study was carried out in Lapui district in Fars province,south of Iran,one of the most important foci of CL in this province.Sample size(237 residents)was calculated based on population.House-to-house survey was done to collect the data regarding knowledge,attitudes,and practices of the inhabitants.The head of each household was interviewed by a trained staff to assess his/her KAP related to CL.A semi-structured KAP questionnaire was used for data collection.Results:Mean age of participants was 39 and more titan half of the respondents were in the age group of 31-40.Males constituted 172(72.5%)of subjects.Most of the respondents(84.3%)were literate.The majority of the study poulation(83%)had heard about SalaJc(local name for CL)and most of these respondents(91%)were aware that CL is presented with a cutaneous lesion.Nearly two-third of the participants(63.5%)stated the bite of mosquito(not specifically sandflies)for CL transmission.The respondents'attitude regarding the treatment of CL was not satisfactory since Only 48%believed that CL can be treated by medicine.A noticeable proportion of respondents(21%)believed in indigenous medicine for the treatment of CL.A small proportion of respondents(14%)stated that traditional healers are good at treating this disease.More than two-third(69%)of respondents believed that the disease is preventable although most of interviewees did not know about preventive measures.Conclusions:In this study,insufficient knowledge of community about infection nature,vector,transmission mode and preventive measures of CL,highlights the needs for a health education initiative to enhance the awareness of people about CL.This would improve inhabitants'contribution in control program of CL in this area.

Predicting the number of visceral leishmaniasis cases in Kashgar, Xinjiang, China using the ARIMA-EGARCH model

Objective:To forecast the visceral leishmaniasis cases using autoregress integrated moving average(ARIMA)and hybrid ARIMAEGARCH model,which offers a scientific basis to control visceral leishmaniasis spread in Kashgar Prefecture of Xinjiang,China.Methods:The data used in this paper are monthly visceral leishmaniasis cases in the Kashgar Prefecture of Xinjiang from 2004 to 2016.The sample data between 2004 and 2015 were used for the estimation to choose the best model and the sample data in 2016 were used for the forecast.Time series of visceral leishmaniasis started on 1 January 2004 and ended on 31 December 2016,consisting of 1790 observations reported in Kashgar Prefecture.Results:For Xinjiang,the total number of reported cases were 2187,the male-to-female ratio of cases was 1:1.42.Patients aged between 0 and 10 years accounted for 82.72%of all reported cases and the largest percentage of visceral leishmaniasis cases was detected among scattered children who accounted for 68.82%.The monthly incidences fitted by ARIMA(2,1,2)(1,1,1)12 model were consistent with the real data collected from 2004 to 2015.However,the predicted cases failed to comply with the observed case number;we then attempted to establish a hybrid ARIMA-EGARCH model to fit visceral leishmaniasis.Finally,the ARIMA(2,1,2)(1,1,1)12-EGARCH(1,1)model showed a good estimation when dealing with volatility clustering in the data series.Conclusions:The combined model has been determined as the best prediction model with the root-mean-square error(RMSE)of 7.23%in the validation phase,which means that this model has high validity and rationality and can be used for short-term prediction of visceral leishmaniasis and could be applied to the prevention and control of the disease.

In vitro activity and in vivo efficacy of a combination therapy of diminazene and chloroquine against murine visceral leishmaniasis

The present study evaluated the in vitro activity and in vivo efficacy of diminazene combined with chloroquine as a potential drug against Leishmania donovani. Amphotericin B was used as a positive control drug. In vitro activity involved incubation of various drug concentrations with promastigotes or vero cells in culture before determination of parasite growth inhibition or cell death while in vivo evaluations involved infection of various mice groups with virulent L. donovani parasites and treatment with test drug compounds following disease establishment. Weight changes in experimental mice were also evaluated before infection and throughout the experiment. The results indicated that the diminazene-chloroquine combination was at least nine times more efficacious than individual drugs in killing promastigotes in culture. The diminazene-chloroquine combination was safer （Ld50=0.03±0.04） than Amphotericin B （Ld50=0.02±0.01）. Body weight in infected mice increased significantly （P=0.0007） from day 7 to day 37 following infection （P=0.026）. However, body weight remained comparable in all mice groups during treatment （P=0.16）. The diminazene-chloroquine combination significantly reduced splenic parasite numbers as compared to individual drug therapies （P=0.0001） although Amphotericin B was still more efficacious than any other treatment （P=0.0001）. Amongst the test compounds, the diminazene-chloroquine combination showed the lowest level of IgG antibody responses with results indicating significant negative correlation between antileishmanial antibody responses and protection against disease. These findings demonstrate the positive advantage and the potential use of a combined therapy of diminazene-chloroquine over the constituent drugs. Further evaluation is recommended to determine the most efficacious combination ratio of the two compounds.

Visceral leishmaniasis: An immunological viewpoint on asymptomatic infections and post kala azar dermal leishmaniasis

Elimination of visceral leishmaniasis is a priority programme in Indian subcontinent.The World Health Organization has set a new target to eliminate kala-azar by the year 2020 as previous target elimination year(2015) has passed.The elimination programme has successfully curbed the rate of infection in endemic regions; however, there are still few challenges in its route.The current drug control regime is extremely limited and comprises only two(amphotericin B and miltefosine) drugs, which are also susceptible for parasites resistance.Moreover, these drugs do not produce sterile cure, and cured patients may develop post kala-azar dermal leishmaniasis even after a decade of cure leaving behind a potent source of parasitic reservoirs for further disease transmission.A significant proportion of endemic population remain seropositive but aymptomatic for many years without any clinical symptom that serve as latent parasitic reservoirs.The lack of tools to identify live parasites in asymptomatic infections and there association in disease transmission, parameters of sterile cure along with post kala-azar dermal leishmaniasis progression remain a major threat in its elimination.In this review, we discuss the potential of host immune inhibitory mechanisms to identify immune correlates of protective immunity to understand the mystery of asymptomatic infections, sterile cure and post kala azar dermal leishmaniasis.

Leishmania donovani whole cell antigen delivered with adjuvants protects against visceral leishmaniasis in vervet monkeys (Chlorocebus aethiops)

In a previous immunogenicity and efficacy study in mice, montanide ISA 720 （MISA） was indicated to be a better adjuvant than bacillus calmette guerin vaccine （BCG） for a Leishmania vaccine. In the present study, we report the safety, immunogenicity and efficacy of Leishmania donovani （L. donovani） sonicated antigen delivered with alum-BCG （A1BCG）, MISA or monophosphoryl lipid A （MPLA） in vervet monkeys following intradermal inoculums. Vaccinated and control animals were challenged with virulent L. donovani parasites and the parasitic burden was determined. Only animals vaccinated with alum-BCG adversely reacted to the inoculum by produc- ing ulcerative erythematous skin indurations. Non-parametric ANOVA followed by a post test showed signifi- cantly higher IgG antibodies, and revealed the presence of lymphoproliferative and interferon gamma responses in both AIBCG＋Ag and MISA＋Ag as compared to the MPLA＋Ag or other groups （P 〈 0.001）. We conclude that L. donovani sonicated antigen containing MISA is safe and is associated with protective immune response against Leishmania donovani infection in the vervet monkey model.

Unusual presentations of cutaneous leishmaniasis in clinical practice and potential challenges in diagnosis:a comprehensive analysis of literature reviews

Cutaneous leishmaniasis is regarded as a re-emerging disease due to its increase in spread and rate of transmission over the past decade due to a proportionate increase in global human movements.This study was therefore carried out to review epidemiology,laboratory diagnosis and treatment with in-depth discussion on some of the rare clinical presentations of the disease capable of influencing its control.The study was based on literature review on clinical and laboratory features of cutaneous leishmaniasis from original research articles,review articles, short communications,letters to editor and case reports on the disease for the past 10 years(April 2000 to April 2010).The results were analysed using simple descriptive methods.The rarest presentations of leishmaniasis encountered were peritibial ulcerations,hard painful nipple in a male,swollen upper lip,dermatofibro sarcoma protuberans,sternal proliferative growth,turban tumour,post operative granuloma,chalazion-like 0.00%,and cutaneous sterile pyogranuloma with asymmetrical alopecia 0.00%each.Others include infected sebaceous cysts 0.45%,syphilis 0.19%,yaws 0.13%,thrombotic ulcerations 0.40%,mycetoma 0.90%,sarcoidosis 0.67%,painless nasal solitary nodule 0.00%,tuberculous lymphadenopathy 0.25%and unilateral erythema nodosum 0.28%.Physicians practicing in cutaneous leishmaniasis endemic,but most especially in the non-endemic areas should bear in mind that the disease may not be that rare in the context of the present global village phenomenon:and that,the next case could just be that of cutaneous leishmaniasis,the clinical picture of the patient notwithstanding.

Geographical distribution and ecological features of the great gerbil subspecies in the main zoonotic cutaneous leishmaniasis foci in Iran

Objective:To reveal subspecies composition of Rhombomy opimus(R.opimus) in Iran. Methods:In this study,field specimens of the gerbil were collected from all its geographical rang in northeast and central parts of Iran and identified on basis of morphological characteristics.Results:Results revealed presence of two subspecies of R.opimus sodalis and R. opimus sargadensis in the country.The first subspecies with brown to hazel-nut color and a size bigger than a typical R.opimus was found only in Golestan province,an isolated colony which is located in plains of north slopes of Alborz Chain Mountains of the country,connected with the Turkmenistan.The subspecies of R.opimus sargadensis with a yellowish color and similar size as a typical R.opimus was found in all other areas of the great gerbil distribution in Iran.There was a distinct topographic difference but similar ectoparasites between colonies of the two subspecies in the study area.Conclusions:Further ecological and genetic investigations are required for more detailed description of the R.opimus subspecies range and structure.The R.opimusPhlebotomus papatasi-Leishmania major association and the ZCL severity and outcome in hosts are discussed.

A review of Leishmaniasis in Eastern Africa

The review presents the epidemiology of leishmaniasis in the Eastern Africa region. We searched PUB MED and MEDLINE with several key words-namely,＂leishmaniasis＇;＂cutaneous＇,＂diffuse cutaneous ＂,＂ mucosal＂, and ＂visceral leishmaniasis＂; ＂kala azar＂ and ＂post kala azar dermal leishmaniasis＂ -for recent clinical and basic science articles related to leishmaniasis in countries in the Eastern Africa region. Poverty, wars, conflicts and migration have significantly aggravated leishmaniases in Eastern Africa. Of particular concern is the increasing incidence of Leishmania-HIV co-infection in Ethiopia where 20-40% of the persons affected by visceral leishmaniasis are HIV-co-infected. Sudan has the highest prevalence rate of post kala-azar dermal leishmaniasis（PKDL） in the world, a skin complication of visceral leishmaniasis（VL） that mainly afflicts children below age ten. In view of its spread to previously non-endemic areas and an increase in imported cases, leishmaniasis in Eastern Africa should be considered a health emergency.