10.1586/ERI.12.148 79 ISSN 1478-7210 © 2013 Expert Reviews Ltd www.expert-reviews.com Review Visceral leishmaniasis (VL) or kala-azar is a chronic, vector-borne parasitic disease, which has fatal consequences without treatment. Leishmania donovani of the genus Leishmania is the causative species of VL in the Indian sub- continent and East Africa, where humans are the sole reservoir (anthroponotic). In Europe, North Africa and Latin America, the disease is caused by other species such as Leishmania infan- tum (syn. Leishmania chagasi ), which have both humans and canines as reservoirs (zoonotic) [1,2] . When an elongated, flagellar, promastig- ote form of the parasite enters the human body, it first infects the peripheral macrophages and grows intracellularly as an oval and nonflagel- lated amastigote. In the later stage of the disease, infection spreads into the visceral organs such as the liver, spleen, lymph nodes and bone marrow. The parasite completes its extracellular digenic lifecycle in the mid gut of the female sandfly of the genus Phlebotomus (for L. donovani ) and Lutzomyia (for L. infantum), the sandfly serves as a vector for the natural transmission of the disease [3,4] . VL is endemic in the tropical and subtropical regions of over five continents that offer suitable habitat for the vectors. It affects more than 88 countries of the world [5] , most of which are in remote rural areas of developing countries where health systems are often weak. Approximately, 0.2–0.4 million cases of VL are estimated to occur worldwide annually. During the last 5 years, more than 58,000 VL cases per year have been reported globally. The six worst affected countries are India, Bangladesh, Sudan, Brazil, Ethiopia and South Sudan, which contribute to more than 90% of all VL cases [6] . However, the actual figure of VL infection may exceed the official data. Because of the limited and poor facilities of government hospitals in endemic areas, many cases appear in private or nongovernment organization hospitals and these cases evade the total VL counts. Sarfaraz Ahmad Ejazi and Nahid Ali* Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, 4 Raja S.C. Mullick Road, Kolkata 700032, India *Author for correspondence: Tel.: +91 332 499 5757 Fax: +91 332 473 0284 nali@iicb.res.in Human visceral leishmaniasis (VL) continues to be a life-threatening neglected tropical disease, with close to 200 million people at risk of infection globally. Epidemics and resurgence of VL are associated with negligence by the policy makers, economic decline and population movements. Control of the disease is hampered by the lack of proficient vaccination, rapid diagnosis in a field setting and severe side effects of current drug therapies. The diagnosis of VL relied largely on invasive techniques of detecting parasites in splenic and bone marrow aspirates. rK39 and PCR, despite problems related to varying sensitivities and specificities and field adaptability, respectively, are considered the best options for VL diagnosis today. No single therapy of VL currently offers satisfactory efficacy along with safety. The field of VL research only recently shifted toward actively identifying new drugs for safe and affordable treatment. Oral miltefosine and safe AmBisome along with better use of amphotericin B have been rapidly implemented in the last decade. A combination therapy will substantially reduce the required dose and duration of drug administration and reduce the chance of the development of resistance. In addition, identification of asymptomatic cases, vector control and treatment of post-kala-azar dermal leishmaniasis would allow new perspectives in VL control and management. KEYWORDS: antileishmanial therapy • antimony resistance • liposomal amphotericin B • miltefosine • PCR diagnosis • rK39 strip test • visceral leishmaniasis diagnosis Developments in diagnosis and treatment of visceral leishmaniasis during the last decade and future prospects Expert Rev. Anti Infect. Ther. 11(1), 79–98 (2013) For reprint orders, please contact reprints@expert-reviews.com