DR. PRISCILLA M. NYAKUNDI

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LEISHMANIASIS THE MISERY OF THIRD WORLD COUNTRIES

• DR. PRISCILLA M. NYAKUNDI
• Principal Research Officer
• Kenya Medical Research Institute
• Nairobi, Kenya
• Brussels 8 February 2006

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NO CASH, NO CUREThe Miserable Pharmaceutical
Market Share For The Poor
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• Estimated 12 million people affected
• Disease endemic in 88 countries
• 1.5. to 2.0 million new cases occurring
  annually
• PRESENTATION OF LEISHMANIASIS
• Visceral Leishmaniasis (VL), 500,000 cases
• Cutaneous/Muco/cutaneous, CL/MCL, PKDL
• 1-1.5 million new cases

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LEISHMANIASIS ON 3 CONTINENTS

• Life threatening visceral leishmaniasis (VL)
• 90 Mutilating mucosal leishmaniasis (MCL)
• Self-healing cutaneous Leishmaniasis (CL)
• Post Kala-azar Dermal Leishmaniasis (PKDL)

• 90of cases live in developing countries India
  especially Bihar, Bangladesh, Nepal, North
  Eastern, Brazil and Sudan.
• Bolivia, Brazil and Peru, Afghanistan,
• Brazil, Iran, Peru, Saudi Arabia and Syria.
• Sudan, Ethiopia, Kenya and India. Mainly in
  people who have recovered from VL following
  treatment. In Kenya PKDL cases occur during VL
  treatment

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PRESENTATION OF VISCERAL LEISHMANIASIS

• Fever
• Anaemia
• Headache
• Nose bleeding
• Wasting
• Enlarged liver and spleen
• Pneumonia or Tuberculosis
• Death if left untreated

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TREATMENT OPTIONS
Drugs available for use Associated
Problems -----------------------------------------
--------------------------------------------------
----------------------------------------------
Pentavalent antimonials Toxic, parasite
resistance growing, 30 days IV treatment in
hospital. Amphotericin B Used in case of
antimonial resistance but dose limiting
toxicity, 15-20 day IV treatment in
hospital Liposomal Amphotericin B Less toxic but
prohibitively expensive (3,884/treatment
except MSF price 840) Miltefosine Terat
ogenic, only registered in India, and
expensive
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DRUGS FOR NEGLECTED DISEASES INITIATIVE (DNDi).
FORMED 2003

• Developing new drugs for Neglected Diseases
  leishmaniasis, sleeping sickness, Chagas disease,
  Bruli Ulcer
• Ensure equitable access of needs-driven products
• Strengthen existing capacity in disease-endemic
  countries
• Build public responsibility and leadership in
  addressing needs of these patients
• Bring together the international community,
  public sector and pharmaceutical industry

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IDENTIFIED NEEDS OF VL PATIENTS

• Easy diagnostic test
• New combinations of existing drugs
• Simple, effective, easy to deliver, affordable,
  short term treatment

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• DNDi INTERVENTION
• LEISHMANIASIS EAST AFRICA PLATFORM (LEAP)
• A group of scientists
• Institutions with expertise in leishmaniasis
• PURPOSE
• To develop clinical trials
• Capacity building
• To bring new treatments to patients

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LEISHMANIASIS EAST AFRICA PLATFORM
- University of Khartoum - Federal Ministry of
Health - MSF- Holland
Sudan
- Addis Ababa University - DACA - Ministry of
Health
Ethiopia
DNDi

IOWH -India IDA WHO/TDR
- Ministry of Health - KEMRI
Kenya
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SANDFLY (PHLEBOTAMUS)VECTOR FOR LEISHMANIASIS
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PATIENT SUFFERING FROM VL
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VISCERAL LEISHMANIASIS
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MUCOCUTANEOUS LEISHMANIASIS (ESPUNDIA)
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MUCOCUTANEOUS LEISHMANIASIS (ESPUNDIA)
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MUCOCUTANEOUS LEISHMANIASIS (ESPUNDIA)
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POST KALA-AZAR DERMAL LEISHMANOID (PKDL)
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BURULI ULCER ON FACE
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BRULI ULCER ON ABDOMEN
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CHILD WITH AIDS
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SLEEPING SICKNESS
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CHAGAS DISEASE BRAIN
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A CRY FOR HELP

• Crucified
• Laid behind a stone
• You live to die
• Rejected and alone
• Like a rose trampled on the ground
• You took the fall and thought of me
• Above all

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REQUESTS TO EUROPEAN PARLIAMENT

• Empower developing countries do Research and
  Development especially on Neglected Diseases
• Increase Government funding for R D for easy
  diagnostic tests cheaper, less toxic drugs
• Increase funding for integrated case management
  Leishmaniasis/HIV
• Assist in the transfer of relevant technology in
  R D of Neglected Diseases
• Strengthen the North South Collaboration to lift
  the developing countries from the current disease
  burden

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Patient cured from Visceral Leishmaniasis
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AKNOWLEDGEMENT

• The European Parliament
• Drugs for Neglected Diseases initiative
• The Director, Kenya Medical Research Institute
• The Kenya Government
• The Patients
• The Audience