The Leishmaniases are an aggregate of diseases named for their causative organisms: protozoan parasites from more than twenty Leishmania species. Leishmania are transmitted through the bites of infected female phlebotomine sandflies (Phlebotomus spp.). Numerous animal species, including humans, have been found as reservoir hosts of Leishmania parasites (Centers for Disease Control and Prevention [CDC], 2013). There are three main forms of the disease: cutaneous, mucocutaneous and visceral. Of the three, Visceral Leishmaniasis (VL), also known as kala-azar (the Hindi term for black fever) is the most severe. VL is characterized by severe weight loss, irregular bouts of fever, enlargement of the liver and spleen, and anemia. A variable incubation period ranges from several weeks to six months or more and the onset of illness can be gradual or abrupt (CDC, 2014b).VL is vastly endemic in the Indian subcontinent and in East Africa and has a near 100% mortality within two years if left untreated (World Health Organization [WHO], 2015a). An estimated 200,000 to 400,000 new cases of VL occur each year worldwide and over 90% of new cases occur in six countries: Brazil, Bangladesh, India, Ethiopia, South Sudan and Sudan (WHO, 2015a).
Laboratory diagnosis of VL in developing countries may be difficult. Most diagnoses in the field are made based on clinical symptoms (CDC, 2014b). Diagnosis and treatment may be complicated by Leishmaniasis’ complex epidemiology. The characteristics of the particular parasite species, the current and past exposure of the population to the specific parasite, and the local ecological features of the transmission sites all have an impact on the presentation and course of the disease (WH...
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... of HIV-infected persons, they are particularly vulnerable to VL. VL also accelerates HIV replication and the progression to AIDS. This presents an additional major challenge in areas where there is high co-infection rate (WHO 2015a).
However, it is the geography and climate of South Sudan which creates the conditions necessary for the existence of VL. The eastern and northeastern area of South Sudan where VL is endemic consists primarily of high-temperature, low-rainfall savannas (grasslands). It is this particular type of acacia–balanite savanna where phlebotomine sandflies live and breed around termite mounds. Largely a rural population, eastern and northeastern South Sudan is dominated by small tribal villages. These villages often built on rock hills or river banks are a natural habitat of hyraxes, thought to be a significant animal host for VL in South Sudan.
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