LEP and malnutrition: In the past, several potential immunomodulators have been tested as effective treatments to overcome immunosuppression against both cutaneous and visceral leishmaniasis.8,28,56–59 As malnutrition is the primary risk factor that contributes to the development of VL, it has been hypothesized that leptin deficiency during Leishmania infection as a result of malnutrition could lead to the impairment of cell-mediated immunity.49 However, leptin levels in acute VL patients have not been measured to substantiate this hypothesis.