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Challenges in the Diagnosis of Visceral Leishmaniasis on the Indian Subcontinent

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Kala Azar in South Asia

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Abstract

Visceral leishmaniasis (VL) or kala-azar, an endemic vector-borne disease, affects populations in the lowest socioeconomic strata living in rural areas on the Indian subcontinent —a group that has limited access to proper health care. Untreated, kala-azar is almost always fatal, and the drugs currently in use are quite toxic. Confirmation of diagnosis before starting therapy is therefore crucial. Early diagnosis and treatment are a key strategy of the Kala-azar Elimination Programme launched in 2005 in Bangladesh , India, and Nepal. VL care must be decentralized to primary health centers to achieve this goal, which has become possible with the availability of rapid diagnostic tests. Parasitological diagnosis is limited to referral hospitals and specialized VL treatment centers. Two serological tests for field use—the direct agglutination test and the rK39 immunochromatographic test (ICT)—have both shown excellent performance on the Indian subcontinent, but the latter is preferred, because it is simpler to use. The proper implementation of these diagnostic strategies within the VL elimination programme involves not only the procurement, training, and supervision of staff, but also quality control both before and after deployment in the field. The logistical requirements are enormous, and therefore standardized guidelines for procurement and quality control must be established.

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Author information

Authors and Affiliations

  1. Drugs for Neglected Diseases Initiative, India Regional Office, PHD House, Siri Institutional Area, New Delhi, 110016, India

    Suman Rijal

  2. Head of Division of International and Humanitarian Medicine, Geneva University Hospitals, 6, rue Gabrielle-Perret-Gentill, Geneva 14, 1211, Switzerland

    François Chappuis

  3. Leishmaniasis Program, Drugs for Neglected Diseases initiative, 15 Chemin Louis-Dunant, Geneva, 1202, Switzerland

    Jorge Alvar

  4. Epidemiology and Disease Control Unit, Department of Public Health, Institute of Tropical Medicine, NAtionalestraat 155, Antwerp, 2000, Belgium

    Marleen Boelaert

Authors
  1. Suman Rijal
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  2. François Chappuis
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  3. Jorge Alvar
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  4. Marleen Boelaert
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Corresponding author

Correspondence to Suman Rijal .

Editor information

Editors and Affiliations

  1. The University of Tokyo Hospital, Bunkyō, Tokyo, Japan

    E. Noiri

  2. Kalazar Research Center, Muzaffarpur, India

    T.K. Jha

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Rijal, S., Chappuis, F., Alvar, J., Boelaert, M. (2016). Challenges in the Diagnosis of Visceral Leishmaniasis on the Indian Subcontinent. In: Noiri, E., Jha, T. (eds) Kala Azar in South Asia. Springer, Cham. https://doi.org/10.1007/978-3-319-47101-3_10

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