A neglected disease of humans: A new focus of visceral leishmaniasis in Bakool,Somalia

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 97; no. 6; pp. 667 - 671
• Main Authors: Marlet, M.V.L., Wuillaume, F., Jacquet, D., Quispe, K.W., Dujardin, J.C., Boelaert, M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2003; Royal Society of Tropical Medicine and Hygiene
• Subjects: Adolescent; Adult; Age Distribution; Aged; Animals; Antimony Sodium Gluconate - therapeutic use; Antiprotozoal Agents - therapeutic use; Child; Child, Preschool; Cysteine Endopeptidases - genetics; epidemiology; Female; Humans; Infant; Leishmania donovani; Leishmania donovani - enzymology; Leishmania donovani - genetics; Leishmaniasis, Visceral - drug therapy; Leishmaniasis, Visceral - epidemiology; Male; Middle Aged; outbreak; Prevalence; Retrospective Studies; Sex Distribution; Somalia; Somalia - epidemiology; visceral leishmaniasis; Somalia; Somalia; epidemiology; outbreak; visceral leishmaniasis; Leishmania donovani
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/S0035-9203(03)80099-8

Visceral leishmaniasis (VL) was observed in children in Bakool region, Somalia, an area where VL hasnot been reported before. We describe the extent of the problem in this war- and famine-stricken area. A retrospective analysis was done of all cases admitted to a VL treatment centre between July 2000 and August 2001. Patients with longstanding fever, splenomegaly and a positive direct agglutination test (DAT; titre > 1:3200) were treated as suspected VL cases. A rapid epidemiological and entomological assessment was performed in the area. Species identification was attempted from blood samples by polymerase chain reaction-restriction fragment length polymorphism analysis of cysteine proteinase B genes. In 1 year, 230 serologically-positive cases were diagnosed as VL, and response to therapy was good in 91.6% of the 225 treated with sodium stibogluconate. Parasitological confirmation was attempted and obtained in 2 cases. Parasites were found to be most similar to Sudanese and Ethiopian reference strains of the Leishmania donovani complex. In a serological survey of 161 healthy displaced persons, 15% were positive by the leishmanin skin test and 3 (2%) were positive by the DAT. The sandfly captures showed Phlebotomus martini and P. vansomerenae. VL seems to be a longstanding and serious health problem in Bakool region. Food insecurity might have contributed to the emergence and detection of VL in this area.