Blog contributor: Jessica M. Keralis
In Peru, a nose that has been flattened and pushed into the face – the characteristic disfigurement caused by leishmaniasis – is referred to as “the mark of the jungle.” In addition to the damaged self-image it causes in people with leishmaniasis, the “mark” comes with a stigma that leads to ridicule from others, shame, and sometimes even being driven from their own communities.1
Leishmaniasis is caused by a protozoan parasite of the genus Leishmania. Humans are infected through a bite from an infected female phlebotomine sand fly and can develop one of three main types of the disease. Cutaneous leishmaniasis, by far the most common form, causes lesions on the skin; there are approximately 1.5 million cases worldwide each year.2 Mucocutaneous leishmaniasis destroys the mucous membranes of the nose, mouth, and throat and often leads to pronounced disfigurement.3 Visceral leishmaniasis is the most severe, which is characterized by fever, weight loss, anemia, and enlargement of the spleen and liver. This disease, called kala-azar (meaning “black fever”) on the Indian sub-continent, occurs in 500,000 people each year and causes approximately 50,000 deaths.4 Leishmaniasis is present in 88 countries, 72 of which are developing countries, on four continents.5 The spread of HIV has compounded the problem: in cases of co-infection, the leishmaniasis parasite accelerates the onset of AIDS by suppressing the immune system and stimulating virus production. Cases of co-infection have been reported in 38 countries on all four continents where the disease is endemic. 6 Unfortunately, the disease is very under-reported: only 32 affected countries require reporting.
The disease burden is exacerbated by the social stigma in response to the effects of the parasite. Many affected are ostracized from their communities because of their disfigurements. In Pakistan and Afghanistan, cutaneous leishmaniasis is called Kal Dana (“the year-long sore”). Affected children are isolated, women are considered unsuitable for marriage and mothers are separated from their children.7 The problem is particularly bad in Nepal, where the caste system prevents “untouchables” from being treated. 1 Ultimately, poverty and ignorance are at the root of leishmaniasis. It is poverty that drives people in Peru into the jungle to cut lumber or pan for gold, to sleep without bednets, and to delay treatment so they can earn for their families. 1 Dr Robert Killick-Kendrick, a leading parasitologist, recently said in an interview with the WHO that while progress in controlling leishmaniasis is slow, there have been encouraging recent developments. 4 He lists five key factors that are important in controlling all vector borne diseases: peace, long-term political commitment, finance, sound control methods likely to succeed, and public health education. “It’s easy to sit in our armchairs and list the problems for the control of VL – or any other vector-borne disease,” he says. “But I am optimistic: with adequate funding, long-term political support and energy coupled with a little imagination, it must be possible to tame this disease, if not get rid of it altogether.”