What is leishmaniasis?

Leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania, transmitted through the bites of infected female phlebotomine sandflies. It occurs in three main clinical forms: visceral (kala-azar — affecting internal organs, almost always fatal without treatment); cutaneous (skin lesions — most common form); and mucocutaneous (destroying mucous membranes of the nose, mouth and throat). It affects some of the world's poorest people in 100+ countries.

What is visceral leishmaniasis?

Visceral leishmaniasis (VL, kala-azar) is caused by L. donovani or L. infantum. Parasites are taken up by macrophages and spread to the liver, spleen and bone marrow — causing fever, progressive weight loss, massive splenomegaly (enlarged spleen), anaemia, thrombocytopenia and ultimately multi-organ failure and death. Without treatment, VL is almost universally fatal. India accounts for approximately 50% of global VL burden.

Why is leishmaniasis called a disease of poverty?

Leishmaniasis thrives in conditions of poverty: sandflies breed in humid, dark environments near overcrowded, poorly constructed housing and animal burrows; malnutrition dramatically increases susceptibility to VL progression; people in poverty cannot afford treatment; and health systems in endemic regions are weakest. Conflict and displacement amplify transmission by pushing people into sandfly-endemic areas without shelter. The disease then perpetuates poverty through its disabling effects.

How does HIV intersect with leishmaniasis?

HIV and VL are mutually reinforcing: HIV immunosuppression allows L. donovani to replicate rapidly, causing VL with atypical presentations and high treatment failure rates. VL accelerates HIV progression. HIV-VL co-infection is particularly severe in Africa and the Mediterranean. Treatment of co-infected patients is complex; secondary prophylaxis is recommended to prevent relapse. The WHO HIV programme integrates VL treatment for co-infected patients.

What treatments are available?

Visceral leishmaniasis: liposomal amphotericin B (LAmB) — gold standard, highly effective, expensive; miltefosine — first oral drug, effective, teratogenic; antimonials (sodium stibogluconate, meglumine antimoniate) — first-line in Africa, decreasing effectiveness in India due to resistance; paromomycin — aminoglycoside antibiotic effective in combination. Cutaneous leishmaniasis: often self-limiting; antimonials, fluconazole, heat therapy or miltefosine used for clinical indications.

What is the Indian subcontinent elimination programme?

India, Bangladesh and Nepal launched a regional VL elimination programme targeting elimination as a public health problem (fewer than 1 case per 10,000 population) by 2023. Strategies: indoor residual spraying (IRS) of deltamethrin in endemic areas; active case detection through rapid diagnostic tests; single-dose liposomal amphotericin B treatment (dramatically simplified); and post-kala-azar dermal leishmaniasis (PKDL) treatment. India's reported VL cases fell from approximately 20,000 in 2010 to approximately 3,000 in 2022 — a dramatic achievement.

Why is cutaneous leishmaniasis stigmatising?

Cutaneous leishmaniasis (CL) causes skin ulcers — most commonly on exposed areas of the face and extremities — that can take months to years to heal and often leave permanent scars. Facial scars cause severe stigma, social exclusion and psychological distress — particularly for women and girls in societies where appearance is linked to marriage prospects and social acceptance. CL is sometimes called the "disease of shame." Treatment reduces healing time and prevents progression to mucocutaneous disease.

What is sandfly control?

Phlebotomine sandflies — the vectors of leishmaniasis — breed in humid, dark microenvironments (soil cracks, animal burrows, rubble, decaying organic matter). Vector control strategies: indoor residual spraying (IRS) with pyrethroid insecticides; insecticide-treated bed nets (sandflies are tiny and can penetrate standard malaria nets — fine-mesh or impregnated nets are needed); environmental management (clearing rubble, improving housing); and insect repellents.

What is the global burden of cutaneous leishmaniasis?

Cutaneous leishmaniasis (CL) is the most common form — with 600,000-1 million new cases annually, predominantly in the Americas (Brazil, Peru, Colombia), Mediterranean basin, Middle East and Central Asia. Afghanistan, Algeria, Brazil, Colombia, Iran, Syria, Tunisia, Ethiopia and Sudan account for approximately 80% of cases. Conflict zones — particularly Syria and Iraq — have seen dramatic surges. CL is severely underreported because it is rarely life-threatening and many cases are treated informally.

Is there a vaccine for leishmaniasis?

No approved human vaccine for leishmaniasis exists. Several candidates are in clinical development — including killed whole-parasite vaccines, protein subunit vaccines and DNA vaccines. A vaccine approved for dogs (CaniLeish, Letifend) reduces canine leishmaniasis in endemic European regions, indirectly reducing human L. infantum exposure. The challenge of developing a human vaccine is complex due to the diversity of Leishmania species and immune evasion mechanisms.

How does GMJ News cover leishmaniasis?

GMJ News tracks WHO NTD Roadmap progress, visceral leishmaniasis elimination in South Asia, cutaneous leishmaniasis in conflict zones (particularly Syria — a concern given Georgian-Syrian community links) and drug access issues. Leishmaniasis is present in Georgia's broader regional context — cutaneous leishmaniasis is endemic in parts of the Middle East accessible via travel from Georgia.

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Leishmaniasis

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

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Leishmaniasis — transmitted by the bite of infected sandflies and caused by more than 20 species of Leishmania parasites — is the world's second-deadliest parasitic killer after malaria: visceral leishmaniasis (kala-azar) is almost universally fatal without treatment, affecting approximately 50,000-90,000 new people per year; cutaneous leishmaniasis affects 600,000-1 million (WHO). An estimated 3.3 billion people are at risk in more than 100 countries across Asia, East Africa, Latin America, Europe and the Middle East. It is a disease of poverty and conflict — with displacement dramatically amplifying transmission.

Key messages

Neglected and deadly

Visceral leishmaniasis (kala-azar) is the world's second-deadliest parasitic disease after malaria — almost universally fatal without treatment. 50,000-90,000 new cases occur per year, predominantly in India, Ethiopia, Kenya, Somalia, Sudan and Brazil.

Three clinical forms

Leishmaniasis occurs in three main forms: visceral (affects organs — liver, spleen, bone marrow; almost always fatal untreated); cutaneous (skin ulcers — most common; 600,000-1 million cases/year); and mucocutaneous (destroys mucous membranes of nose, mouth and throat).

Disease of poverty and conflict

Leishmaniasis is strongly linked to poverty — affecting the poorest communities in LMICs, worsened by malnutrition, crowded housing and displacement. Armed conflict dramatically amplifies transmission in endemic areas.

Sandfly vector

Leishmaniasis is transmitted by the bite of infected female phlebotomine sandflies. Sandflies breed in humid, dark environments (soil cracks, animal burrows, rubble). Insecticide-treated bed nets and indoor residual spraying are effective vector control tools.

Treatments exist but are imperfect

Several treatments are available — amphotericin B (gold standard, but toxic and expensive), antimonials (first-line in some regions, resistance increasing), miltefosine (oral, only drug for oral treatment of visceral leishmaniasis) — but none are ideal for LMIC settings.

WHO 2030 elimination target

WHO targets elimination of visceral leishmaniasis as a public health problem in the Indian subcontinent (India, Bangladesh, Nepal) by 2023 — and in all endemic countries by 2030. India has achieved dramatic reductions through integrated vector control and case management.

Key statistics

3.3B

people at risk in 100+ countries

WHO

50-90K

new visceral cases/year

WHO

600K-1M

new cutaneous cases/year

WHO

~100%

fatality untreated (visceral)

WHO

2030

WHO elimination target

WHO NTD Roadmap

deadliest parasitic disease after malaria

WHO

Visceral leishmaniasis cases reported globally (thousands) — WHO 2000-2022

Source: WHO. Major decline in Indian subcontinent from elimination programme. Africa accounts for increasing share.

Glossary of key terms

Leishmania
WHOA genus of protozoan parasites (about 20 species) transmitted by phlebotomine sandflies. Different species cause different clinical forms: L. donovani and L. infantum cause visceral disease; L. major, L. tropica cause cutaneous disease; L. braziliensis causes mucocutaneous disease.

Visceral leishmaniasis (VL)
WHOKala-azar — the most severe form, caused by L. donovani or L. infantum. Parasites invade the liver, spleen and bone marrow, causing fever, weight loss, massive splenomegaly, anaemia and pancytopenia. Almost universally fatal without treatment. Immunocompromising conditions (HIV) dramatically worsen prognosis.

Cutaneous leishmaniasis (CL)
WHOThe most common form — causing skin lesions that can leave permanent scars. Usually self-limiting but can take years to heal. Mucocutaneous progression (from some L. braziliensis strains) destroys facial tissues. Treatment reduces healing time and prevents mucocutaneous progression.

Post-kala-azar dermal leishmaniasis (PKDL)
WHOA skin rash developing months to years after apparent cure of visceral leishmaniasis — predominantly in Sudan and India. Affected people serve as a reservoir for ongoing transmission. Treatment is important for elimination.

Liposomal amphotericin B (LAmB)
WHOThe current gold-standard treatment for visceral leishmaniasis — highly effective and relatively safe. High cost ($1,500-3,000/treatment) limits access in LMICs. A single-dose regimen achieves >95% cure in the Indian subcontinent.

Miltefosine
WHOThe first and only oral drug for visceral leishmaniasis — a major advantage for LMIC settings. Cure rates >95% in Indian subcontinent settings. Teratogenic — cannot be used in pregnant women. Emerging resistance is a concern.

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Leishmaniasis

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Glossary of key terms

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