WHO guidelines on leishmaniases: treatment of visceral leishmaniasis and post-kala-azar dermal leishmaniasis in eastern Africa and South-East Asia

The World Health Organization has revised its guidelines for the management of two types of leishmaniasis – visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL) – in specific regions of Africa and Asia. Eastern Africa, identified as the most severely impacted ecoepidemiological subregion, accounts for 73% of the global VL cases reported to WHO in 2023.

VL is endemic in several African nations, including Chad, Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan, and Uganda, where it is caused by Leishmania donovani infection. This disease can be fatal if not treated promptly.

The updated guidelines introduce a revised safety profile for miltefosine, which highlights a reasonable possibility of ocular adverse events being linked to the drug, accompanied by risk-mitigation measures. They also present new treatment regimens for PKDL in both eastern Africa and South-East Asia. Furthermore, alternative treatment options are suggested for patients presenting with primary VL in these regions.

The guidelines include advice on managing VL relapses in South-East Asia. Additionally, they provide weight-band-based allometric dosing of miltefosine and indicators for monitoring the implementation of these new recommendations. The WHO directives are intended for healthcare professionals, managers of national leishmaniasis control programs, policy-makers, and partners operating within endemic countries.