Human leishmaniases: epidemiology and public health aspects.

The leishmaniases are parasitic diseases caused by different species of Leishmania, protozoa transmitted by sandflies, haematophagous biting insects. The reservoir hosts are man (anthroponotic cycle) and domestic or wild animals (zoonotic cycle). In man the disease takes four main clinical forms: visceral, cutaneous, mucocutaneous and diffuse cutaneous. Morbidity and mortality due to leishmaniasis are on the increase. Leishmaniasis, which is now found on four continents, is endemic in 82 countries (21 in the New World and 61 in the Old). The large number of endemic countries shows the global scale of the problem, though it is particularly severe in certain countries (90% of cases of visceral leishmaniasis come from 4 countries). Annual incidence is estimated at some 600,000 new clinical cases, officially reported, with a global prevalence of 12 million cases and a population at risk of approximately 350 million. It is very difficult to provide realistic estimates given the frequency of subclinical forms of visceral leishmaniasis, the large number of undiagnosed or unreported cases, the frequent absence of active screening and the fact that the leishmaniases are notifiable diseases only in a few countries (30 out of 82); nevertheless, it seems clear that official reporting of cases considerably underestimates the problem. Over the last two decades, it has become clear that leishmaniasis is a growing public health problem in terms of geographical extent and incidence with the occasional severe epidemic, such as that which occurred in Sudan.(ABSTRACT TRUNCATED AT 250 WORDS)