During the last decade,
visceral leishmaniasis has been reconsidered in its epidemiology and strategies for diagnosis, treatment and prevention. This vectorial disease, responsible for more than 50,000 deaths each year across India, East Africa, South America, the Mediterranean area, Central Asia and China, is currently spreading over new territories. This formerly rural disease has even reached cities in South America. This spreading is caused by environmental changes due to global warming or human activity, and by the movement of workers and refugees. As a consequence, the burden of HIV/Leishmania
coinfection is increasing in many developing countries even though effective antiretroviral
therapy has led to a marked decrease in its incidence in Europe. The disease is now handled differently than it was 10 years ago: PCR has become the most accurate tool for diagnosis and follow-up in developed countries, and field diagnostic tools have been developed (antigenuria, rK39 dipstick). While resistance to antimoniate has appeared in India and Europe, new
therapies have been evaluated such as
miltefosine, the first oral
therapy, or short treatment with
liposomal amphotericin B. In France,
liposomal amphotericin B has supplanted antimoniate
meglumine because of better tolerance and shorter hospitalization duration. Protecting dogs through immunization or collars impregnated with
deltamethrin proved effective to prevent zoonotic
leishmaniasis due to Leishmania infantum.