One of the most neglected of the infectious diseases of poverty, visceral leishmaniasis (kala azar), will be the subject of a new research project in Ethiopia.

The project, entitled “Studies on the ecology and transmission dynamics of visceral leishmaniasis in Ethiopia”, will seek to determine the drivers of transmission of the disease, of which there an estimated 500,000 cases worldwide annually. The worst affected region in Africa is southern Sudan and northwest Ethiopia.

The research will be carried out by the Hebrew University of Jerusalem Kuvin Center for the Study of Infectious and Tropical Diseases, supported by a $5 million grant from the Bill & Melinda Gates Foundation. For further information see press release.

The parasite that causes leishmaniasis is in most cases transmitted by the bite of the sandfly. However, in Brazil - where the disease is becoming more common - sandflies show low rates of infection with the parasite. Does this mean that other disease vectors are responsible?

Dogs are known to be a reservoir of the infection and researchers at Paulista State University suggest that dog fleas may be implicated in leishmaniasis transmission. In a study - published in Veterinary Parasitology and discussed on SciDev.Net - they took fleas from 22 leishamania-infected dogs and injected samples of the fleas into 22 hamsters. This led to the development of infection in four or six (depending on the test method used) of the hamsters.

This is a small study and it has not established whether the fleas pass on the parasite between dogs. It does not yet provide any indication of whether the dog fleas then pass transmit the disease to humans. But it indicates that this possibility should be investigated further.

A fascinating account of research on leishmaniasis and Chagas disease has been published on the website of Mexico’s Universidad Autonoma de Nuevo Leon (UANL).

The focus of medical entomologist Doctor Eduardo A. Rebollar Tellez and his colleagues is on the insect vectors of leishmaniasis and Chagas disease. Both of these kinetoplastid diseaseses are present in Mexico. The work of Dr Tellez is part of an inter-disciplinary project, “Complex ecological networks: applications to the emerging diseases and biodiversity”.

The UANL article may be accessed here.

The Inter-American Development Bank and the Global Network for Neglected Tropical Diseases have announced their intention to mobilize $30 million from the public and private sectors to raise awareness and funding for the control and elimination of neglected tropical diseases (NTDs) in the Americas region. Technical assistance for the initiative will be provided by the Pan American Health Organization (the regional office of the World Health Organization).

The announcement was made at the annual meeting of the Clinton Global Initiative in New York - see press release.

The meeting heard that soil transmitted helminths and Chagas disease cause the greatest NTD burden in the Americas, followed by dengue, schistosomiasis, leishmaniasis, trachoma, leprosy, and lymphatic filariasis. More than 230 million people in the region are currently living with these devastating diseases.

Partners involved in the new initiative range from the Brazilian soccer team to pharmaceutical giant GlaxoSmithKline (GSK) and Partners for Philanthropic Change.

GSK has also recently announced that it will provide Brazil with some of its vaccine technology and also fund research in Brazil for a vaccine for dengue fever - see Wall Street Journal.

A Lancet “World Report” examines the increasing incidence of visceral leishmaniasis in eastern Africa. Each year, this kinetoplastid disease affects around 500,000 people worldwide, killing roughly 50,000. Two-thirds of all leishmaniasis patients are believed to be in southeast Asia. The second largest foci is east Africa where, according to this article, there may be as many as 40,000 new cases every year.

The report goes on to explore the difficulty monitoring visceral leishmaniasis due to poor diagostics and data surveillance, a surge in leishmania/HIV coinfection in Ethiopia and the Sudan, the shortcomings of the therapies available to treat visceral leishmaniasis, as well as future efforts to control the spread of the disease.

The neglected infection leishmaniasis is a problem in many parts of the Middle East but it rarely receives attention in national media. A report in the Yemen Times focuses on the case of one child with the disease and goes on to look at the wider issue of providing treatment for the mainly poor rural Yeminis who have leishmaniasis.

Few doctors in the rural areas are able to diagnose the disease and even in the capital city there are problems with the supply of drugs to treat it.

The Pan American Health Organization (PAHO) has a Program for the Elimination of Neglected and Other Poverty-Related Diseases. The Program is calling for expressions of interest in two consultancies, one on disease mapping and modelling and the other on the social determinants of disease. The deadline for the expressions of interest is 10th July 2009.

The purpose of the disease mapping consultancy is “to conduct or improve disease mapping of the selected neglected infectious diseases (NIDs) that can be targeted through mass drug administration (MDA), i.e. onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma, as well as other diseases that could be part of an integrated plan, including Chagas disease, rabies transmitted by dogs, plague, leprosy, leishmaniasis, and congenital syphilis, among others”. Details are available here.

The purpose of the social determinants consultancy is “to analyze the social determinants of health associated with neglected infectious diseases (NIDs) (i.e. living conditions, cultural factors, etc.), as well as possible key interventions to mitigate them in order to reduce the burden of selected NIDs that can be targeted through mass drug administration (MDA)—i.e. onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma—as well as other diseases that could be part of an integrated plan, including Chagas disease, rabies transmitted by dogs, plague, leprosy, leishmaniasis, and congenital syphilis, among others”. Details may be found here.

TropIKA.net reported earlier on the second stakeholder conference of the Drugs for Neglected Diseases initiative (DNDi) held in Nairobi. Now, an article from the IPS news service includes an interview with Marcel Tanner, chairman of DNDi’s board of directors, given during the event. He discusses the problems resulting from the lack of adequate treatments for diseases such as leishmaniasis and human African trypanosomiasis (sleeping sickness).

Using the phrase “neglected diseases, neglected people”. Marcel Tanner describes the attitude of the pharmaceutical industry towards tropical diseases that primarily affect the marginalised poor.

Grants to fund research into leishmaniasis, one of the most neglected of neglected diseases, are few and far between, despite the fact that it threatens 350 million people worldwide. A team of researchers at Canada’s McGill University which will receive $26 million dollars “to develop new medications to treat certain infections and chronic diseases that do not receive sufficient attention from the pharmaceutical industry” seems likely to devote at least some of the money to leishmaniasis according to a press release from the university.

The leader of the research group, David Thomas, notes that when his daughter contracted the disease during a visit to South America, she was “treated by a therapy using the same heavy metals that they’ve been using since the 1940s. The therapy hasn’t moved on”.

Let us hope that the McGill team can indeed start things moving.

Ben Fogle is a British presenter of TV programmes that often involve challenging expeditions to remote locations. On one of his expeditions he contracted leishmaniasis, as reported in a BBC news story. Fortunately he is now recovering. What follows is an open letter to Ben Fogle from TropIKA.net.

Dear Ben

Congratulations on making good progress in your recovery from cutaneous leishmaniasis. It is fortunate that you seem to have avoided the even more serious form of the disease – visceral leishmaniasis.

Many people who have heard of your illness have probably come away with the impression that you picked up an incredibly rare tropical infection. You will, however, be aware that leishmaniasis is actually very common. While it is hard to be sure how many people are affected, the World Health Organization estimates that 350 million people in 88 countries are at risk.

Leishmania parasites, as you probably know, belong to a class of protozoa known as the Kinetoplastida. Two other serious (and very common) diseases are also caused by kinetoplastids – sleeping sickness (human African trypanosomiasis) and Chagas disease. Animals are also affected; cattle in many African countries die from trypanosomiasis, which has a big impact on agriculture and on the economies of these countries.

Tropical diseases are in the news these days more than used to be the case. Malaria in particular is attracting a lot of attention. This may be in some part due to the number of celebrities who have come forward to support malaria research and control efforts. Well known malaria activists in the UK include David Beckham and Tony Blair, and Bill Gates now provides much of the money that supports malaria research. Another former political leader, President Jimmy Carter, has become a central figure in efforts to fight a number of other tropical diseases, including Guinea worm and river blindness. Groups of scientists who specialise in other tropical infections have also done a good job in highlighting the harm that ‘their’ diseases cause.

But no one is championing the cause of the kinetoplastid diseases! This is a pity as more research into these diseases is badly needed. For some tropical diseases there are already some pretty effective treatments available, although getting them to all the people who need them is another matter. In contrast, the drugs available for leishmaniasis, sleeping sickness and Chagas are not so effective and they have side effects …as you know!

As someone who has personal experience of a kinetoplastid disease, a good knowledge of tropical regions and a large personal following, you would make an ideal leishmaniasis (or kinetoplastid disease) champion. Finding out about these diseases and the – as yet – limited research going on could also make some great television. Certainly there would have to be some visits to some very exotic locations in Africa, Asia and South America.

Should you want to contact researchers and also doctors actually treating patients with these diseases, TropIKA.net would be delighted to make some introductions. And tens of thousands of people with leishmaniasis and other kinetoplastid diseases would certainly be pleased to see someone draw international attention to the need to find new approaches to prevention and cure.

Best wishes for your continuing recovery. TropIKA.net readers will look forward to hearing from you.

Paul Chinnock
Editor in Chief, TropIKA.net

Copies of this letter were sent to Ben Fogle via his agent.