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Leishmaniases in Bolivia: Comprehensive Review and Current Status

The leishmaniases are protozoan, zoonotic diseases transmitted to human and other mammal hosts by the bite of phlebotomine sandflies. Bolivia has the highest incidence of cutaneous leishmaniasis (CL) in Latin America (LA), with 33 cases per 100,000 population reported in 2006. CL is endemic in seven of the country’s nine administrative departments. Visceral leishmaniasis (VL) is comparatively rare and is restricted to one single focus. Most CL cases are caused by Leishmania (Viannia) braziliensis (85% cases); VL is caused by L. (L.) infantum. Seven sandfly species are incriminated as vectors and Leishmania infections have been detected in several non-human mammal hosts. Transmission is associated with forest-related activities, but recently, cases of autochthonous, urban transmission were reported. Because most cases are caused by L. (V.) braziliensis, Bolivia reports the greatest ratio (i.e., up to 20% of all cases) of mucosal leishmaniasis to localized CL cases in LA. Per national guidelines, both CL and VL cases are microscopically diagnosed and treated with pentavalent antimony.

Received September 12, 2008. Accepted for publication January 28, 2009.

Acknowledgments: The authors thank past and present colleagues for logistic and technical support that contributed to the work described in the manuscript. We also thank three anonymous peer reviewers for constructive comments on the manuscript.

Financial support: Previous and current CUMETROP work on the leishmaniases has been supported by the Belgian Agency for Cooperation and Development, the European Commission, the UNICEF/UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases, and the Wellcome Trust.

Disclaimer: The opinions expressed in this paper are those of the authors and may not reflect the position of their employing organization nor of their work’s sources of funding.

^* Address correspondence to Richard Reithinger, Disease Control and Vector Biology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: rreithinger{at}yahoo.co.uk

Authors’ addresses: Ana Lineth García, Rudy Parrado, Ernesto Rojas, Raúl Delgado, Av. Aniceto Arce No. 371, Facultad de Medicina IIBISMED-CUMETROP, Universidad Mayor de San Simón, Cochabamba, Bolivia. Jean-Claude Dujardin, Department of Parasitology, Prince Leopold Institute for Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium. Richard Reithinger, Disease Control and Vector Biology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

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