Re-emergence of visceral leishmaniasis in Gujarat, India.

Background: Leishmaniasis is a major public health problem causing significant morbidity and mortality in Africa, Asia and Latin America. It presents mainly in three clinical forms, of which visceral leishmaniasis (VL) is the most severe form. Recent outbreaks of VL in India and the epidemic of human immunodeficiency virus (HIV) make VL a re-emerging problem in India1. Outbreaks and epidemics of leishmaniasis have also been associated with urban development, deforestation, environmental changes and population migrations. Individual risk factors such as HIV, malnutrition, genetic factors, etc. are also responsible for epidemiological diversity of leishmaniasis2. Approximately, a total 500,000 VL cases occur annually worldwide of which more than 23,000 cases are from India. The present foci of VL in India are Bihar, West Bengal, Uttar Pradesh and Jharkhand3. Sporadic cases have also been reported from Gujarat (west India)4, Tamil Nadu and Kerala (south India) and subHimalayan parts of north India including Uttar Pradesh, Himachal Pradesh and Jammu and Kashmir5. To the best of our knowledge and available literature, after 1986 no case of VL has been reported from Gujarat so far. It is a common belief that western India has become VL free zone but this case study shows that the population of Gujarat state is again at risk of kala-azar after about 20 years.