AI Article Synopsis
- - Visceral Leishmaniasis (VL), caused by the Leishmania donovani parasite transmitted by sandflies, is becoming a concern as it spreads to previously unaffected high-altitude regions in Nepal, threatening elimination efforts.
- - An exploratory study showed a significant decrease in VL cases in program districts, while cases have increased in non-program districts over the past decade, highlighting a concerning trend.
- - Molecular testing confirmed the presence of L. donovani in some patients from non-program districts, indicating that VL may be emerging as a new threat in these areas, emphasizing the need for attention and resources.
Article Abstract
Background: Visceral Leishmaniasis (VL) is caused by a protozoan parasite Leishmania donovani that is transmitted to humans by an infected female sandfly, Phlebotomus argentipes. VL is common in the Indian sub-continent including Nepal and efforts for its elimination are ongoing. However, expansion of disease towards the higher altitude areas, previously considered as VL free in Nepal, may impact the ability to achieve the elimination target by 2020.
Methods: This was an exploratory study, where VL suspected patients living exclusively in the non-program districts of Nepal and presenting with fever > 2 weeks and splenomegaly was included. The patients' blood samples were collected, and DNA was extracted. DNA was subjected to PCR amplification and subsequent sequencing. Additionally, past 10 years data of VL cases from the national databases were analysed to see the trends of the disease in program and non program districts.
Results: Analysis of the past 10 years data revealed that trend of VL cases significantly decreased in the program districts (p = 0.001) while it increased in the non-program districts (p = 0.002). The national trend for overall incidence of VL also significantly decreased over this time period. Limited number of patients' samples (n = 14) were subjected to molecular investigation, and four patients were found to be positive for Leishmania species by PCR. Interestingly, these cases in non-program districts were indeed also L. donovoni complex. All four patients were male with age ranges from 10 to 68 years. GenBank BLAST of the obtained DNA sequences confirmed identified specimens as L. donovani complex. We identified additional VL cases from non-program districts (including the high lands) of Nepal, indicating that the infection could be an emerging threat for the non-program areas of Nepal.
Conclusion: The demonstration of VL cases in areas initially considered non-endemic has raised concern about on-going transmission in those regions and may trigger subsequent government plan and action to include those areas in the elimination program. Thus, the government should consider revising the disease control programs to accommodate non-program districts for achieving the VL elimination goal set for 2020.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528229 | PMC |
| http://dx.doi.org/10.1186/s12879-019-4083-3 | DOI Listing |
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Article Synopsis
- - Visceral Leishmaniasis (VL), caused by the Leishmania donovani parasite transmitted by sandflies, is becoming a concern as it spreads to previously unaffected high-altitude regions in Nepal, threatening elimination efforts.
- - An exploratory study showed a significant decrease in VL cases in program districts, while cases have increased in non-program districts over the past decade, highlighting a concerning trend.
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Barriers of Visceral Leishmaniasis reporting and surveillance in Nepal: comparison of governmental VL-program districts with non-program districts.
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February 2019
UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland.
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