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Aid / Disasters

Leishmaniasis: the flesh-eating, dog-culling war plague

By BS MediaTwitter Profile | Published: Tuesday, 19 January 2016
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The word "leishmaniosis" is not particularly familiar in the West. In the industrialised world, it is not a condition we are likely to come crosswise with any regularity. Elsewhere, the shadow cast by leishmaniosis is seldom out of sight.

leishmaniosis lesions are sometimes referred to as "1-year sores."
Image credit: CDC/Dr. D.S. Martin

In galore environment of the world, leishmaniosis is scarily commonplace. For the populations of poorer, hotter countries, the unwellness is a specter that haunts their daily lives. It has the ability to kill, injure and ostracize.

According to the World Health Organization (WHO), an estimated 12 million people are septic with leishmaniosis crosswise 98 countries.

As galore as 20,000-30,000 die at the hands of the unwellness yearly; millions more are for good scarred.

Roughly 90% of leishmaniosis cases are to be found in just five countries: India, Bangladesh, Nepal, Sudan and Brazil.

Often referred to as a "flesh-eating" condition, leishmaniosis is a parasitic unwellness that can be fatal if adequate health care is not received. Despite its prevalence, the West appears to be comparatively ignorant of its horrors.

In this article, we will take a brief look at what leishmaniosis is, how it spreads and what mightiness be done to limit its reach.

What is leishmaniosis and who is at risk?

leishmaniosis is a unwellness spread by a Protozoan parasite from the innocent-looking sand fly. At least 90 species of sand fly and upward of 20 species of Leishmania parasite work in conjunction to spread the dangerous unwellness.

The cycle of infection begins when the sand fly feasts on the blood of an septic mammalian. It then returns the parasite to the warmth of a new host with its next feed. Once inside the body, the parasite sets up shop inside the host's immune cells, generally the macrophages.

Macrophages are designed to kill intruders and break them into their constituent environment, but the leishmaniosis parasite is well-designed to avoid their onslaught. The Protozoa uses nucleon pumps to protect itself from the acidic environment inside the macrophages and acid phosphatases to disarm the host's enzymes; in this way, the Leishmania parasite is able to survive in the most hostile of environments.

It seems that this pairing of Phlebotomus sand fly and Leishmania parasite has been working against humanity since time old. Some believe the alleged plague of boils in the Bible mightiness refer to leishmaniosis:

Exodus 9:9: the "breaking out in sores on man and beast throughout the land of Egypt."

The people most at risk of the unwellness are those who live in areas frequented by the sand fly species that carry the parasite. These species are suited to a number of very different environments; they can thrive in forests or comeuppance or anyplace warm in between. This makes the unwellness's medicine many-sided and improbably difficult to control.

In general, it is the poorer nations of the world who are at sterling risk. This is partially because leishmaniosis relies on a host's immune system to be weakened by unwellness or deficiency disease before it can take hold of the victim. in addition, the conditions of poorness, as we shall see later, make the perfect breeding ground for sandflies.

In the US, according to the CDC, leishmaniosis is improbably rare. Other than a small number of cases in Oklahoma and Texas, individuals with the unwellness have always recently returned from countries where leishmaniosis is resident.

Types of leishmaniosis

Because of the large variety of Leishmania parasites, the unwellness itself has a range of possible characteristics. In general, there are three major types of leishmaniosis, defined as follows:

Fast facts about leishmaniosis
  • leishmaniosis is caused by a parasite transmitted by a sand fly bite
  • At least 98 countries are septic by leishmaniosis
  • The conditions created by a war zone favor leishmaniosis transmission.

Learn more about parasites

  1. Cutaneous leishmaniosis (CL): CL is the most common form of the unwellness and is the origin of its "flesh-eating" nickname. Ulcers appear at the site of the sand fly's bite, they do not easily heal and leave permanent scars on the skin. The "diffuse" version of CL produces lesions crosswise the entire body that match Hansen's disease. Two thirds of new cases occur in Afghanistan, Algeria, Brazil, Colombia, Iran and Syria

    Approximately 0.7 million-1.3 million new cases of CL are according each year

  2. Visceral leishmaniosis (VL): besides best-known as visceral leishmaniasis (black fever), the symptoms include fever, weight loss, anemia and enlarged variety meat, particularly the spleen and liver. This variant is fatal if left untreated. The majority of cases are to be found in Bangladesh, Brazil, Ethiopia, India, South Sudan and Sudan

    There are around 200,000-400,000 new cases of VL according worldwide each year

  3. Mucocutaneal leishmaniosis (ML): ML is the rarest of the three types. If left unbridled, it can wholly destroy the membrane membranes of the nose, mouth and throat. Without treatment, ML is generally fatal. An estimated 90% of ML cases occur in Bolivia, Brazil and Peru

    The number of ML cases that occur each year is unbest-known.

Worst affected by leishmaniosis are countries where the majority of the population live in poorness; on with Chagas unwellness, dengue fever and sleeping sickness, leishmaniosis is classed as a "neglected unwellness."

These neglected unwellnesss receive little research funding. They are considered "unwellnesss of poorness."

The social impact of cutaneal leishmaniosis

aboard the apparent health implications of open sores in a poorness-stricken environment, the lesions caused by CL can have significant social ramifications.

A case of leishmaniosis in Jerusalem, 1917 - best-known in the region as "Jericho buttons."
Image credit: Library of Congress

Because the lesions of CL occur at the site of the sand fly bite, they are much more prevailing on exposed areas of skin, so much as the hands and face. In other words, they are clearly visible.

In a survey conducted on the women of Kabul, a large majority believed the wounds caused by CL were transmissible by human-to-human contact or by "sharing meals and family goods."

People with the unwellness can be ostracized; women suffer particularly harsh consequences, being deemed unfit for marriage or raising children.

More than 1 in 5 of the questionnaire's respondents aforesaid that a mother with CL should not bottle-feed her child; more than half admitted they would not let an afflicted individual touch or hug their child.

It is not difficult to imagine the negative psychological impacts of being ostracized, mistrusted and even feared.

in addition, women are less likely to seek treatment for the unwellness because of the attached stigma.

War and leishmaniosis

Although leishmaniosis can only be contractile by a bite from a sand fly, people moving en masse shot in poorness stricken areas where these vectors are present can increase the rate of transmission.

For a number of reasons, war is a leading factor in leishmaniosis epidemics. The living conditions that go hand in hand with conflict benefit the sand fly and put people in harm's way:

  • Poor housing and lack of healthful conditions can increase sand fly breeding rates
  • Sleeping in huddled areas encourages sandflies to visit for regular blood meals
  • Low-quality diets that lack iron, macromolecule, nutriment A and zinc increase the risk that an infection will take hold
  • Movements of non-immune world into new areas where different strains of leishmaniosis may thrive have no protection against the unwellness.


In 2004, in the thick of war and turmoil, the troubled city of Kabul baby-faced some other kick in its not yet troubled backbone. leishmaniosis took hold. An estimated 67,500 cases were according in the city alone, making it the biggest center for leishmaniosis in the world.

The presence of ungathered sewerage in the streets was (and is) a major factor in eruptions and a prevalence of great gerbils (Rhombomys opimus) as a reservoir for the parasites compounds the problem. For the last decade, Kabul has been one of the worst-affected cities in the world.

Syria today

leishmaniosis has been present in Syria for galore years, often referred to in the literature as "Aleppo boil" or the "1-year sore." In the past, the unwellness has been contained and well-managed, but Syria's present strife has worsened conditions on the far side all measure.

The current conditions in Syria are perfect for the transmission of leishmaniosis.

The exact number of cases is not best-known, the country is divided and taking accurate stock of unwellness is not presently possible.

Conditions for the spread of leishmaniosis are perfect, and the mass exodus of medical professionals and rapid disintegration of infrastructure has only combined the problem.

A direct and purposeful assault on medical institutions set waste to their health care capabilities. According to the WHO, 40% of Syria's ambulances have been destroyed and 57% of public hospitals are significantly damaged, with 37% wholly out of service.

An estimated 80,000 doctors have emigrated and hundreds more have been dead or imprisoned.

Some individuals in Europe and the US have raised concerns that an inflow of Syrian refugees mightiness spark an eruption of leishmaniosis on home soil. But, because transmission is dependent upon the bite of a sand fly, this is not a concern of any substance.

Added to this, leishmaniosis generally does not create symptoms in world. To take hold and manifest the unwellness, the individual must be significantly immunological disorder and/or suffering from deficiency disease.

Combating leishmaniosis

Modern drugs are effective at dominant and halting leishmaniosis' progression; in addition, topically specific environmental projects are on-going to minimize the number of sandflies, their ability to breed and their access to human flesh.

Effective medicines are available, but bar is key.

As far as pharmaceuticals are concerned, VL can be treated by liposomal antibiotic B (an antifungal), a combination of power antimonials, paromomycin (antibiotic) and miltefosine (antimicrobial).

For CL, paromomycin, fluconazole (antifungal) or pentamidine (antimicrobial) have shown some level of success.

Environmental interventions vary significantly dependent on the type of environment being considered, but methods include insect powder spraying, distribution of insect powder-treated nets and environmental management of areas particularly suited to sand fly breeding.

As with galore efforts in unwellness control, education and communication programs are as essential as distribution and access to drugs. Early detection and ensuant treatment helps stem the flow of human vectors.

Could a large-scale dog cull save the day?

Although, in the countries most troubled by leishmaniosis, world appear to be the major reservoir of the unwellness, some scientists believe that dog populations could besides play a part.

There is no question that the leishmaniosis parasite can live in dogs, but how it impacts the level of unwellness in the human population is heatedly debated.

Whether dog-culling mightiness help in the fight against leishmaniosis is being heatedly debated in the Americas.

In some areas of Brazil, a country with one of the worst leishmaniosis problems, up to 50% of dogs have been found to carry the parasite that transmits the most sinister variant of the unwellness - VL.

Veterinarians are required by law to check dogs for the parasite and, if found, the animal is euthanized. This sounds sensible, but it is causation a backlash. It is easy to imagine the trauma experient by a dog owner who takes their pet for a routine visit to the vets only to have it put down and incinerated, despite the animal showing no outward signs of unwellness.

To make matters worse, the test for the leishmaniosis parasite throws out more than 20% false-positives, so there is a 1 in 5 chance that your beloved pet has been killed entirely without reason.

There is much discussion as to the effectiveness of dog culls. It is unclear how much difference it can make. In fifties China, a leishmaniosis eruption sparked an extensive dog cull. Animal control personnel aimed to kill at least 75% of all dogs in the worst affected areas.

The Chinese cull did seem to work ab initio, but 4 years later, the leftover dogs had an even higher prevalence of Leishmania infection than prior to the cull.

some other issue that accompanies a dog cull is the human response to a lost pet. One Brazilian study found that roughly 40% of dog owners whose pet had been culled fleetly went out and invested with in some other dog. Often this new dog was a puppy and ensuantly more prone to infection. inside months, slightly less than 40% of these replacement pets had besides been euthanized.

Mathematical modeling is being wheelless out in an effort to estimate the benefits of culling. The jury is, and will be for some time, out.

The future of leishmaniosis

To end on a low note, the prevalence of sandflies and their proximity to world is only set to increase the burden of leishmaniosis on the global population. Deforestation and the ensuant movement into areas colonized by sandflies increases the chances of infection.

Added to this, global warming is widening the sand fly's territory. bantam changes in temperature can have a prodigious impact on the potential range of these vectors.

Of course, the troubles in the Middle East are not looking likely to evaporate anytime shortly, maintaining one of the major hotbeds of leishmaniosis infection. Without a pointed effort to control, educate and design better treatments, leishmaniosis is set to continue casting its shadow.

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