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In the 1990s, the measure of ”Disability-Adjusted Life Years (Lost)“ (DALY) was developed, which attempts to quantitatively describe the global socio-economic burden of a disease. It estimates the years lost by death or impaired by disability, whereby the extent of disability is included in the calculation. Thus, DALYs describe the difference between reality and the ideal that all humans reach their average life expectancy in complete health.
With the introduction of DALYs it was documented that, according to this estimation, Malaria (82.7 Mio. DALY)1, HIV/Aids (81.6 Mio DALY) and Tuberculosis (49.4 Mio DALY) constitute the most important poverty-related diseases by far. Therefore, the large international funding agencies decided to concentrate on these ”Big 3“. The reaction of Médecins sans Frontières was to coin the term Neglected Tropical Diseases (NTDs) for all those diseases that had not been acknowledged but collectively also cause extensive human suffering and economic damage (21.0 Mio DALY)2.
Salmonellae are a main cause for bloodstream infections - infections with high fatality rates - in sub-Saharan Africa. Until recently, salmonellae could be treated well with antibiotics. However, like in Europe, the numbers of drug-resistant bacteria are on the rise in Africa.
Rickettsiae are small bacteria that grow inside cells. There are several species, which are transmitted by fleas, lice, ticks or mites and cause different kinds of disease. Rickettsia typhi causes so-called endemic typhus, leading to severe complications in some cases. It may occur worldwide.
The parasite Entamoeba histolytica may survive in the human intestine for years without causing symptoms. For unknown reasons, the amoebae at some point start invading the intestinal wall and blood vessels causing bleeding ulcers and abscesses, respectively, if they end up in organs.
The most widespread form of the leishmaniases is cutaneous leishmaniasis (oriental sore), which initially causes a swelling, followed by a chronic skin ulcer. Leishmaniae allow themselves to be taken up by immune cells, so-called macrophages, but in many humans resist digestion and killing by the macrophages. A rationale approach to treatment is, therefore, to activate and enable macrophages to digest the parasites.
With an estimated 12 Mio affected humans, leishmaniases belong to the most relevant NTDs. Some Leishmania species only affect the skin, others the skin-mucosal transitions causing mutilating disfigurations. Yet others infect inner organs and cause life-threatening generalized diseases.