Kala azar in India
Overview of Kala-azar in India
Kala-azar in India refers to the occurrence and management of visceral leishmaniasis in the Indian subcontinent. Kala-azar, also known as black fever, is a severe form of leishmaniasis caused by the Leishmania donovani parasite. It is transmitted by the bite of infected female sandflies of the genus Phlebotomus.
Epidemiology
Kala-azar is endemic in several states of India, including Bihar, Jharkhand, Uttar Pradesh, and West Bengal. Bihar alone accounts for a significant proportion of the global burden of the disease. The disease primarily affects the rural poor, with outbreaks often occurring in areas with poor housing and sanitation.
Transmission
The Leishmania donovani parasite is transmitted to humans through the bite of infected Phlebotomus argentipes sandflies. The sandfly becomes infected by biting an infected human or animal host. The disease is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anemia.
Clinical Features
Patients with kala-azar typically present with prolonged fever, significant weight loss, and splenomegaly. The disease can be fatal if left untreated, primarily due to complications such as secondary infections and severe anemia.
Diagnosis
Diagnosis of kala-azar is confirmed through laboratory tests, including the detection of the parasite in tissue samples or serological tests such as the rK39 dipstick test.
Treatment
Treatment of kala-azar in India has evolved over the years. Historically, antimonial compounds were used, but due to resistance, newer treatments such as liposomal amphotericin B, miltefosine, and paromomycin are now preferred. The Indian government has implemented various programs to provide free treatment to affected individuals.
Prevention and Control
Efforts to control kala-azar in India focus on reducing the sandfly population through insecticide spraying, improving housing conditions, and early diagnosis and treatment of cases to reduce transmission. Public health campaigns aim to raise awareness about the disease and its prevention.
History
Kala-azar was first identified in India in the 19th century. Significant contributions to the understanding and treatment of the disease were made by Indian scientist Upendra Nath Brahmachari, who developed the urea stibamine treatment in the early 20th century.
Impact
Kala-azar has a significant impact on public health in India, particularly in impoverished regions. The disease affects thousands of people annually, leading to economic and social burdens on affected communities.
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Contributors: Prab R. Tumpati, MD