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Control strategies for visceral leishmaniasis (VL) and mucocutaneous leishmaniasis (MCL) in South America: applications of molecular epidemiology.


A full and detailed understanding of the transmission cycles and epidemiology of visceral leishmaniasis (VL) and mucocutaneous leishmaniasis (MCL) is necessary to develop disease control and surveillance. Molecular epidemiology and population genetics can resolve the diversity and structure of Leishmania populations, for ex. the intricate relationships between clinical forms of human infection and mammal reservoirs. Research will involve comparative investigations between endemic areas for VL and MCL in Par aguay, Peru, Brazil and Venezuela and will strengthen local capacities for research and for Latin Am-European collaborations. The technical aim is to develop a full range of microsatellite markers and multi-locus sequencing typing (MLST) of housekeeping ge nes for the Leishmania braziliensis complex and for L guyanensis. We will also establish in South America the procedures for microsatellite and MLST analysis for L infantum, which have been developed and proven as epidemiological tools by a European networ k. The practical aims are to encourage the application of these and other molecular epidemiological methods in S. America for 1. elucidating parasite-vector-host relationships 2. assessing the epidemiological impact of VL-HIV co-infection (Brazil) 3. asses sing the epidemiological importance of recombinant Leishmania genotypes and 4. assessing the spread of resistance against 1st line treatment (SbV). In addition we will compare genotypes of a) Leishmania isolated from diverse clinical cases of leishmaniasis and b) drug susceptible and drug-resistant strains. The project will be undertaken in the context of an investigation of present understanding and intervention strategies among health professionals, defining how best to introduce project outputs into impr oved control. An accessible South American repository for Leishmania will be established, incorporating an existing collection, new isolates and representatives from other endemic regions.

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