Visceral Leishmaniasis: Evaluation of Diagnostic Tools, Therapeutic Regimens, and Associated Risk Factors in Areas with Frequent Outbreaks in South Sudan and Sudan: Case Reports and Review of Literature

Introduction: Visceral leishmaniasis of genus Leishmania donovaniis a known cause of Kala-azar, with an agentof Phlebotomusspecies. Other species of public health importance include Phlebotomus-martini that engulfed SouthSudan bordering counties with Kenya whereas Phlebotomus-orientalisdominates northern parts of South Sudanand Sudan. It exhibits rare behavioral characteristics of outer door bites. Among Eastern African countries, SouthSudan is a highly endemic area where more than 1/3 of the population is at risks of infections. This review aimed toevaluate the current diagnosis, treatment and risk factors associated with epidemics and mortality due to VisceralLeishmaniasis in Sudan and South Sudan.Methodology and Objective:Literatures published in SCI Journals, pub med, and science direct, Google, WHOreports, MSF, and CDC websites were searched starting from 1945 to 2018. Visceral leishmaniasis/VL diagnostictools, treatment regimens, and associated risk factors were the keywords used during browsing. Details referred toGiven Figures in the methodology section.Findings: Several risk factors contributed to the frequency of VL outbreaks. Chronic wars, malnutrition andsettlement in areas infested by the sand fly, co-infections with either HIV or Hepatitis an emerging public healthconcern. Government efforts to control and eliminates the vectors of VL are lacking with negligible resourcesallocation. Acacia trees are proved to harbor sand fly as resting and hiding places. K39/K26 or rk39/rk28 dipstick is afield base diagnostic tool commonly used. Treatments with liposomal AmporicinB, sodium stibogluconate plusparomomycin are recommended for use in South Sudan. This review also revealed that areas formerly free fromKala-azar had experience recurrent epidemic.Conclusion:VL in South Sudan remains highly isolated from clinical diagnosis, treatment, and control strategies.Routine data for surveillance is also an absence. National guidelines and protocols for treatment, and vector controlremain at standstill. The level of resistance of visceral Leishmania parasites to the available anti-leishmanial drugsrequired more researches. There is a close relationship between frequent VL outbreaks and internal conflicts, poormalnutrition, poverty and displacement to high transmission zones, individuals who are new in sand fly infestedareas are at greater risks, including children, elderly and pregnant women.