MSF-USA: Kala Azar

Doctor Ingrid Herder examining a child in the Kala Azar ward of MSF's health centre in Huddur, Somalia.

Largely unknown in the developed world, leishmaniasis is a parasitic disease which threatens many poor countries, The disease principally affects poor communities in isolated regions, often as devastating epidemics. In Sudan, where civil war had caused a flood of internal refugees, an epidemic of visceral leishmaniasis lasted from 1984 to 1994 and claimed more than 100,000 lives in the Western Upper Nile province, a third of the population of the affected area.

Transmission and symptoms

The disease is caused by one of over 20 varieties of parasitic protozoa called leishmania. The disease is endemic in 88 countries, infecting around two million people each year. It is estimated some 59,000 people died from the disease in 2001, mostly from its most severe form, visceral leishmaniasis, also known as kala azar (Hindi for "black fever"). Over 90 percent of visceral leshmaniasis cases occur in five countries: Bangladesh, Brazil, India, Nepal, and Sudan. The parasite is transmitted by the bite of certain types of sandflies, which live principally in forest areas in sub-tropical and tropical climates. Both animals and humans can act as the parasite's reservoir: the sandfly picks up the parasite by biting a host and then transmits it to another.

Leishmaniasis is prone to epidemics, especially when previously unexposed populations are forced by war and famine to move into endemic areas. Unfortunately, there is presently little international cooperation on dealing with these epidemics.

Treatment

Treatment of leishmaniasis has been hampered by the inadequacies and high price of existing medicines and slow progress on research and development into new cures.

A patient suffering from Leishmaniasis at the health center in Satipo, Peru.

The most common treatment for visceral leishmaniasis was developed in the 1930s, using derivatives of antimony. Sodium stibogluconate (SSG) is taken as an intramuscular injection over 30 or more days. It is available under the brand name Pentostam from GlaxoSmithKline, as well as from generic producers. Another antimonial drug is meglumine antimoniate (brand name Glucantime).

SSG is still effective in many regions and can produce good cure rates. But resistance to the drug is a growing problem — especially in India, where as many as 65 percent of patients are resistant. Further, a course of treatment is long (30 days), painful, and causes toxic reactions in some patients. Pentostam is also relatively expensive: $273 per patient.

Doctors Without Borders/Médecins Sans Frontières (MSF) and Leishmaniasis

Since 1988, MSF has treated more than 60,000 patients with leishmaniasis, principally in East African countries, including Sudan, Ethiopia, and Uganda, but the best of efforts are dwarfed by the limitations of existing treatments and world's lack of interest in this forgotten disease.