Volume 9 ; Issue 2 ; in Month : July-Dec (2026) Article No : 178
Deepak SK, Fazal B, Karim MJ, et al.

Abstract

Visceral leishmaniasis (VL), commonly known as Kala-azar, is one of the most severe neglected tropical diseases caused primarily by intracellular protozoan parasites belonging to the Leishmania donovani complex. Despite significant advances in disease control, VL continues to pose a major public health challenge, particularly in tropical and subtropical regions of South Asia, East Africa, and South America. The disease is transmitted through the bite of infected female phlebotomine sandflies and is characterized by persistent fever, hepatosplenomegaly, pancytopenia, weight loss, and progressive immune dysfunction. The pathogenesis of VL involves complex interactions between Leishmania parasites and host immune responses, including parasite survival within macrophages, modulation of cytokine networks, oxidative stress regulation, and immune evasion mechanisms. This review provides a comprehensive overview of the epidemiology, transmission dynamics, and global burden of visceral leishmaniasis, while highlighting recent advances in understanding its molecular and cellular pathogenesis. Current diagnostic approaches, including parasitological examination, serological assays, antigen detection methods, and molecular techniques such as polymerase chain reaction (PCR), are critically discussed with emphasis on their sensitivity, specificity, and clinical applicability. Furthermore, conventional therapeutic strategies, including amphotericin B formulations, miltefosine, paromomycin, and combination regimens, are evaluated alongside emerging approaches such as nanotechnology-based drug delivery systems, immunomodulatory therapies, vaccine development, host-directed therapies, and novel antileishmanial compounds. An improved understanding of parasite biology, host–pathogen interactions, and mechanisms of therapeutic resistance is essential for developing safer, more effective, and sustainable interventions. This review emphasizes the need for integrated approaches combining early diagnosis, optimized treatment strategies, surveillance programs, and innovative therapeutic platforms to achieve effective control and eventual elimination of visceral leishmaniasis.

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