Recent advances in the diagnosis and treatment of kala-azar

Abstract

In India, about 100 000 cases of visceral leishmaniasis (VL) or kala-azar are estimated to occur annually, 90% of which occur in the state of Bihar. Currently, antibody-based tests such as the rK39-based immunochromatographic strip test and the direct agglutination test (DAT) are widely used for the diagnosis of VL. However, their major drawback is continued positivity both long after cure and in a high proportion of individuals living in endemic areas. Thus, antibody-based tests must always be used in combination with a standardized clinical case definition for VL. There have been many breakthroughs in the past decade in the treatment of kala-azar in India, such as approval of oral miltefosine and paromomycin, single-dose treatment with liposomal amphotericin B and multidrug treatment. Encouraged by these advances, an ambitious VL elimination programme was launched with the aim to eliminate VL as a public health problem in India, Nepal and Bangladesh by 2015. Early diagnosis, complete treatment of cases, integrated vector management, effective disease surveillance, and clinical and operational research should be the five key components of the strategy to achieve this goal.