aka Black Fever, Kala Azar
Development News from Afghanistan
The 10 year old Afghan girl has big eyes, a shy smile, and a dark lesion speckled with blood on her right cheek. The girl has leishmaniasis, a disease caused by a parasite transmitted by a tiny sandfly that can lead to severe scarring, often on the face. The girl, wearing a purple tunic, trousers, and pale blue shoes, answers “no” softly when asked if the sore hurts. But her father is worried about the lesion, the size of a big coin.
“Of course, this doesn’t look good,” the father said, at a leishmaniasis clinic crowded with children with sores in the Afghan capital, Kabul. [The man] said he first noticed a mark on his daughter’s face 2 months ago. “It was a very small dot but it grew and grew. If it grows any more it will cover her whole face.”
A survey in 2003 by HealthNet International in Faizabad, Badakshan province, Afghanistan, found that 8.3 per cent of the surveyed people had cutaneous leishmaniasis lesions. The last WHO (World Health Organization) update on the situation, from 22 May 2002, estimated that there were 200,000 cases in Kabul alone, but it may well have deteriorated since then.
Although cutaneous leishmaniasis can be traced back many hundreds of years, one of the first and most important clinical descriptions was made in 1756 by Alexander Russell following an examination of a Turkish patient. The disease, then commonly known as “Aleppo boil”, was described in terms which are relevant: “After it is cicatrised, it leaves an ugly scar, which remains through life, and for many months has a livid colour. When they are not irritated, they seldom give much pain.”
The leishmaniases are caused by 20 species pathogenic for humans belonging to the genus Leishmania, a protozoa transmitted by the bite of a tiny 2 to 3 millimetre-long insect vector, the phlebotomine sandfly.
Leishmaniasis currently threatens 350 million men, women and children in 88 countries around the world. The leishmaniases are parasitic diseases with a wide range of clinical symptoms: cutaneous, mucocutaneous and visceral.
Jeff Jacoby, Town Hall
As Time magazine noted, Muller’s chemical “kills the mosquitoes that carry malaria, the flies that carry cholera, the lice that carry typhus, the fleas that carry the plague, the sand flies that carry kalaazar and other tropical disease.” Thanks to his discovery, “the tropics are becoming safer places to live; because of it, typhus” — a deadly scourge long associated with wars and disaster — “was no serious threat in World War II.”
The name of this miracle formula? Dichlorodiphenyltrichloroethane — better known as DDT.
Extraordinary Ordinary Women
The Institute for OneWorld Health is about to submit documents for approval for its first drug, an antibiotic that can cure visceral leishmaniasis more effectively and for a fraction of the cost of existing drugs. Now Hale and her team are turning their attention to drugs and vaccines to fight other diseases, including malaria and childhood diarrheal diseases.”
Hale went into greater detail about their first victory, the effort to eradicate visceral leishmaniasis (VL). “It is curable, but you probably haven’t heard much about it because those who get it are very poor and very rural. It kills – who knows how many. And the disease is from a single cell parasite that you get from the bite of a sand fly. The parasite goes to the spleen and the liver and then it goes to the bone marrow. Parasites are brilliant. This one knocks out the ability to make white blood cells and red blood cells. Bihar is the center of the epidemic, with one half of the world’s VL located right there. The opportunity exists to eliminate the disease if we have the will. It doesn’t get much easier than this to eliminate a disease.”
“Our first success was with paromomycin,” Hale continued, “which costs about $10 for a 21-day therapy and gives you a lifetime cure. It gave us proof of concept as a nonprofit pharmaceutical. But drug approval is not enough. You have to get it to people. That’s how you save lives. We were warned by everyone not to do distribution. We had to turn on its head the notion that advanced technology is not for everyone, that it is only for is in the west. You must always turn complexity on its head and make it simple by looking at it another way.”
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