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Visceral leishmaniasis: a One Health approach
  1. Victor J. Del Rio Vilas, DVM, MBA, MSc, PhD,
  2. Ana N. S. Maia-Elkhoury, DM, MSc,
  3. Zaida E. Yadon, MD, MSc, PhD,
  4. Ottorino Cosivi, DVM and
  5. Manuel J. Sanchez-Vazquez, DVM, MSc, PhD
  1. Communicable Diseases and Health Analysis, Panaftosa, Pan American Health Organization, Duque de Caxias, Rio de Janeiro, Brazil
  1. e-mail: vdelrio{at}

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LEISHMANIASIS is a vectorborne, protozoan disease caused by infection with Leishmania species transmitted by infected phlebotomine sandflies. This article focuses on visceral leishmaniasis, which results in the most severe clinical forms of the disease. It also focuses on Latin American and the Caribbean and Europe, where the zoonotic form of visceral leishmaniasis is prevalent.

In the case of zoonotic visceral leishmaniasis, the role of the dog as the main vertebrate reservoir is well established (Dantas-Torres and others 2012), making visceral leishmaniasis a good example of the importance of embracing a One Health approach for efficient disease surveillance and control.

In people, visceral leishmaniasis infections can be asymptomatic or develop into clinical forms comprising fever, weight loss, splenomegaly and hepatomegaly. If left untreated, visceral leishmaniasis results in death in 90 per cent of human cases. When treated, the fatality rate drops considerably, ranging from 1.5 to 8.4 per cent depending on the region. However, immunocompromised individuals are more prone to developing clinical disease and have higher case fatality rates (up to 20 per cent when treated) (WHO 2007, PAHO/WHO 2013, Alvar and others 2012).

Clinical features of visceral leishmaniasis infection frequently reported in dogs include skin lesions, ocular inflammation or injury, weight loss, lethargy, inappetence and lymphadenomegaly.

Leishmaniasis has been reported in 98 countries on five continents (WHO 2010). More than 90 per cent of the estimated 300,000 new cases per year of visceral leishmaniasis in humans occur in just six countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil (WHO 2014a). In Europe, visceral leishmaniasis is caused by Leishmania infantum and transmitted by Phlebothomus perniciosus (WHO 2014b). Visceral leishmaniasis is endemic to 14 countries in southeastern and western Europe, with around 500 autochthonous new human cases reported annually; 73 per cent of these are in Albania, Italy …

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