Elimination of Kala-Azar from the Southeast Asia Region

Sujit K. Bhattacharya General Medicine, Glocal Hospital, Krishnanagar, West Bengal, India.

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Aditya Prasad Dash Central University of Tamil Nadu, Tiruvarur, India.

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Visceral leishmaniasis (VL), popularly known as kala-azar, is essentially a disease of poverty. Kala-azar is caused by a parasite, Leishmania donovani. Recent review indicates that worldwide 98 countries are endemic for kala-azar. Approximately 0.2–0.4 million new VL cases occur each year worldwide. More than 90% of global VL cases occur in Bangladesh, Brazil, Ethiopia, India, South Sudan, and Sudan. This trend is slowly changing due to the progress in kala-azar elimination in southeast Asia, where Bangladesh has reported an average of some 600 new cases in 2014−2015. With the advancement in our knowledge about the disease and development of tools to diagnose and treat VL, it was considered that elimination of kala-azar was possible from India, Nepal, and Bangladesh. The three countries signed a memorandum of understanding in 2005 for collaboration. Miltefosine is the first ever oral drug developed to treat VL, which was later replaced by lipid amphotericin B. The main components of the strategy are early diagnosis using rK39 strip test and complete treatment utilizing miltefosine for 28 days. Dichlorodiphenyltrichloroethane or pyrethroids were deployed for vector control. There was much to be desired for better performance of the vector control activity. Pharmacovigilance and monitoring of drug resistance were the weakest part of the program. In the post-elimination phase, surveillance reinforced by active case finding will of a crucial factor for sustainability of the elimination. A strong political will is required to ensure elimination of kala-azar from the Indian subcontinent and its sustainability in the post-elimination phase.

Author Notes

* Address correspondence to Sujit K. Bhattacharya, General Medicine, Glocal Hospital, Krishnanagar 741102, West Bengal, India. E-mail: sujitkbhattacharya@yahoo.com

Authors' addresses: Sujit K. Bhattacharya, General Medicine, Glocal Hospital, Krishnanagar, West Bengal, India, E-mail: sujitkbhattacharya@yahoo.com. Aditya Prasad Dash, Central University of Tamil Nadu, Tiruvarur, Tamil Nadu, India, E-mail: apdash@gmail.com.

  • 1.

    Sundar S, Chakravarty J, 2012. Recent advances in the diagnosis and treatment of kala-azar. Natl Med J India 25: 8591.

  • 2.

    Sundar S, Jha TK, Thakur CP, Bhattacharya SK, Rai M, 2006. Oral miltefosine for the treatment of Indian visceral leishmaniasis. Trans R Soc Trop Med Hyg 100 (Suppl 1): S2633.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Bhattacharya SK, Jha TK, Sundar S, Thakur CP, Engel J, Sindermann H, Junge K, Karbwang J, Bryceson AD, Berman JD, 2004. Efficacy and tolerability of miltefosine for childhood visceral leishmaniasis in India. Clin Infect Dis 38: 217221.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Singh OP, Singh B, Chakravarty J, Sundar S, 2016. Current challenges in treatment options for visceral leishmaniasis in India: a public health perspective. Infect Dis 5: 19.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Sundar S, Singh A, Chakravarty J, Rai M, 2015. Efficacy and safety of miltefosine in treatment of post-kala-azar dermal leishmaniasis. Scientific World Journal 41: 4378.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Ostyn B, Hasker E, Dorlo TP, Rijal S, Sundar S, Dujardin JC, Boelaert M, 2014. Failure of miltefosine treatment for visceral leishmaniasis in children and men in south-east Asia. PLoS One 9: e100220.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Sundar S, Singh A, 2013. What steps can be taken to counter the increasing failure of miltefosine to treat visceral leishmaniasis? Expert Rev Anti Infect Ther 11: 117119.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Sundar S, Chakravarty J, 2013. Leishmaniasis: an update of current pharmacotherapy. Expert Opin Pharmacother 14: 5363.

  • 9.

    Sundar S, Sinha P, Jha TK, Chakravarty J, Rai M, Kumar N, Pandey K, Narain MK, Verma N, Das VN, Das P, Berman J, Arana B, 2013. Oral miltefosine for Indian post-kala-azar dermal leishmaniasis: a randomised trial. Trop Med Int Health 18: 96100.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Bhattacharya SK, Sur D, Karbwang J, 2006. Childhood visceral leishmaniasis. Indian J Med Res 123: 353356.

  • 11.

    Kishore K, Kumar V, Kesari S, Dinesh DS, Kumar AJ, Das P, Bhattacharya SK, 2006. Vector control in leishmaniasis. Indian J Med Res 123: 467472.

  • 12.

    Bhattacharya SK, Sur D, Sinha PK, Karbwang J, 2006. Elimination of leishmaniasis (kala-azar) from the Indian subcontinent is technically feasible and operationally achievable. Indian J Med Res 123: 195196.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Bhattacharya SK, Sinha PK, Sundar S, Thakur CP, Jha TK, Pandey K, Das VR, Kumar N, Lal C, Verma N, Singh VP, Ranjan A, Verma RB, Anders G, Sindermann H, Ganguly NK, 2007. Phase 4 trial of miltefosine for the treatment of Indian visceral leishmaniasis. J Infect Dis 196: 591598.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Sundar S, Singh A, Rai M, Chakravarty J, 2015. Single-dose indigenous liposomal amphotericin B in the treatment of Indian visceral leishmaniasis: a phase 2 study. Am J Trop Med Hyg 92: 513517.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Sundar S, Jha TK, Thakur CP, Sinha PK, Bhattacharya SK, 2007. Injectable paromomycin for visceral leishmaniasis in India. N Engl J Med 356: 25712581.

  • 16.

    Singh OP, Hasker E, Sacks D, Boelaert M, Sundar S, 2014. Asymptomatic Leishmania infection: a new challenge for Leishmania control. Clin Infect Dis 58: 14241429.

    • PubMed
    • Search Google Scholar
    • Export Citation
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