India stands on the brink of eliminating visceral leishmaniasis, commonly known as kala azar. With a marked decline in reported cases and deaths, the nation has come close to meeting the elimination target set by the World Health Organization (WHO).Bangladesh, India’s neighbour, was the first country validated by the WHO for eliminating kala azar as a public health problem.
Kala-Azar
- Visceral leishmaniasis commonly known as kala-azar, is a slow-progressing indigenous disease caused by a protozoan parasite of genus Leishmania.
- It is also known as Black Fever or Dumdum Fever.
- In India Leishmania donovani is the only parasite causing this disease.
Transmission and Symptoms
- It is transmitted by sandflies. Sandflies of the genus Phlebotomus argentipes are the only known vectors of kala-azar in India.
- It causes fever, weight loss, and spleen and liver enlargement. If left untreated, it can be fatal in 95% of cases.
- Recorded Cases in India:
- India documented 530 cases and four deaths in 2023, a decline from previous years.
- Additionally, there were 286 cases of post-kala azar dermal leishmaniasis (PKDL).
Post Kala-azar Dermal Leishmaniasis
- This condition arises when Leishmania donovani infiltrates and thrives within skin cells, resulting in the formation of skin lesions.
- In some instances of kala-azar, PKDL emerges after treatment, but now it is believed that PKDL might occur without going through the visceral stage. However, more data is needed to understand how PKDL develops.
- The visceral stage refers to the initial phase of visceral leishmaniasis (kala-azar), where the parasite affects internal organs.
Treatment
- In India, the primary treatment for kala-azar involves administering injectable liposomal amphotericin B.
- For PKDL, the standard treatment consists of 12 weeks of oral miltefosine, with the dosage adjusted based on the patient’s age and weight.
- Strategies for Elimination in India:
- Effective Spraying: Rigorous monitoring of indoor residual spraying to curb sandfly breeding and disease spread.
- Wall Plastering: Using Gerrard soil for wall plastering to minimize sandfly breeding areas.
- Treatment Compliance: Ensuring completion of PKDL treatment through the ASHA (Accredited Social Health Activist) network.