Visceral Leishmaniasis: Evaluation of Diagnostic Tools, Therapeutic Regimens, and Associated Risk Factors in Areas with Frequent Outbreaks in South Sudan and Sudan: Case Reports and Review of Literature

Abstract

Introduction: Visceral leishmaniasis of genus Leishmania donovani is a known cause of Kala-azar, with an agent of Phlebotomus species. Other species of public health importance include Phlebotomus-martini that engulfed South Sudan bordering counties with Kenya whereas Phlebotomus-orientalis dominates northern parts of South Sudan and Sudan. It exhibits rare behavioral characteristics of outer door bites. Among Eastern African countries, South Sudan is a highly endemic area where more than 1/3 of the population is at risks of infections. This review aimed to evaluate the current diagnosis, treatment and risk factors associated with epidemics and mortality due to Visceral Leishmaniasis in Sudan and South Sudan. Methodology and Objective:Literatures published in SCI Journals, pub med, and science direct, Google, WHO reports, MSF, and CDC websites were searched starting from 1945 to 2018. Visceral leishmaniasis/VL diagnostic tools, treatment regimens, and associated risk factors were the keywords used during browsing. Details referred to Given Figures in the methodology section.Findings: Several risk factors contributed to the frequency of VL outbreaks. Chronic wars, malnutrition and settlement in areas infested by the sand fly, co-infections with either HIV or Hepatitis an emerging public health concern. Government efforts to control and eliminates the vectors of VL are lacking with negligible resources allocation. Acacia trees are proved to harbor sand fly as resting and hiding places. K39/K26 or rk39/rk28 dipstick is a field base diagnostic tool commonly used. Treatments with liposomal AmporicinB, sodium stibogluconate plus paromomycin are recommended for use in South Sudan. This review also revealed that areas formerly free from Kala-azar had experience recurrent epidemic.Conclusion: VL in South Sudan remains highly isolated from clinical diagnosis, treatment, and control strategies. Routine data for surveillance is also an absence. National guidelines and protocols for treatment, and vector control remain at standstill. The level of resistance of visceral Leishmania parasites to the available anti-leishmanial drugs required more researches. There is a close relationship between frequent VL outbreaks and internal conflicts, poor malnutrition, poverty and displacement to high transmission zones, individuals who are new in sand fly infested areas are at greater risks, including children, elderly and pregnant women.