Kala azar in India

Kala-azar (Hindustani: काला आज़ार (Devanagari) کالا آزار (Nastaleeq) kālā āzār), is derived from kala which means black in Sanskrit, as well as in the languages descended from it, including Hindi and Urdu; the word azar is a Persian loanword in Hindustani that means "fever"; as such the disease is named for the darkening of the skin on the extremities and abdomen that occurs in the disease. It is also pronounced kālāzar (कालाज़ार کالا زار). ==Types==

A 2012 report based on 2004-8 data estimated that the number of new annual cases of kala azar was at least 146,000 in India, 12,000 in Bangladesh, and 3,000 in Nepal. Kala azar Kala azar, also called visceral leishmaniasis, is a disease in which a parasite migrates to the internal organs such as the liver, spleen (hence "visceral"), and bone marrow. If left untreated, will almost always result in the death of the host. Signs and symptoms include fever, weight loss, fatigue, anemia, and substantial swelling of the liver and spleen. Among people with kala azar, there is variation in the symptoms, and some people can have unusual symptoms. Asymptomatic kala azar Asymptomatic kala azar (also called asymptomatic Leishmania infection) occurs when someone has the infection but does not show symptoms. For every 1 person with kala azar symptoms, 4–17 people may have asymptomatic kala azar. Risk of asymptomatic kala azar is high for anyone in close contact with a person with kala azar. Most people who would test positive for asymptomatic kala azar will clear the infection naturally. Between 1–23% of asymptomatic people will develop kala azar within 1 year. Post-kala-azar dermal leishmaniasis Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL); it is characterised by a macular, maculopapular, and nodular rash in a patient who has recovered from VL and who is otherwise well. Despite being called "post kala azar", 29% of cases appear from people who never had kala azar, and who had an asymptomatic infection previously. ==Vector==

In various places in the world different sandflies transmit different Leishmania parasites which cause different variations of kala azar. In the Indian subcontinent the particular sandfly is Phlebotomus argentipes and it transmits Leishmania donovani. One part of preventing the disease in India is preventing the insect bite. If that information were available, then it would be easier to study when insects bite, how they choose to bite either animals or humans, and where they breed. Tests of cattle, buffalo, chickens, wild rats, and dogs found little or no infection. There is some evidence that goats could be reservoirs of infection. ==Treatment==

Kala azar is a community problem and requires individual and community participation in treatment. While the drug works for short term treatment of VL, PKDL would require a longer treatment of more than 28 days with this drug. Miltefosine is not recommended for use as a monotherapy to treat PKDL. ==Elimination of disease==

The eradication of kala azar in India is achievable and there are favorable circumstances for doing so. One part of the elimination strategy was to reduce sandflies as a vector by giving mosquito nets treated with DDT along with programs for early case detection and treatment. Challenges Major challenges in eliminating kala azar is lack of access to health care, planning for drug resistance, the absence of a kala azar vaccine, and the difficulty in controlling the insect spreading the infection. Progress in diagnosis, treatment, and the development of a vaccine is significant and is guiding the elimination planning. Public health programs The India National Health Policy, 2002 set a goal to eliminate kala azar by 2010. The Central Government of India started supporting states with case registration in 2003. In 2005 the governments of India, Nepal, and Bangladesh started an initiative with the World Health Organization to collaborate in eliminating kala azar in the region. India changed the target year to 2015. In February 2015 the health ministers of India, Bangladesh, and Nepal joined with the health ministers of Thailand and Bhutan to set a new target date to eliminate kala azar by 2017. ==History==

researched kala-azar in Kolkata himself. The death rate is drastically declined from nearly 6300 to 750 within ten years in Assam. India has long been involved in drug development for kala azar. William Twining, an East India Company military physician, wrote a modern medical description of kala azar in 1835. In 1903 William Boog Leishman, a British Army medical officer, reported from Dum Dum near Calcutta identifying parasites which cause kala azar. His report was correct, and scientists gave his name to the parasite Leishmania and to the Western name of the disease, leishmaniasis. India's National Malaria Eradication Programme was using DDT between 1953 and 1964 as the insecticide to prevent malaria. DDT is highly effective was banned for also being toxic to humans and the environment. After 1964 and the halt of DDT use, kala azar returned, but physicians no longer recognized the disease after its absence. In 1978 in Nepal, people reported the disease. From 1980 the disease spread among many people. ==Special populations==

Quackery is common enough to be a significant problem in treating the disease. The government seeks to make official clinics accessible, but many people take services from unlicensed medical practitioners. Men are more likely than women to get kala azar. Children with kala azar have the same symptoms as adults. Miltefosine is as effective and well tolerated as a treatment in children as adults and can be a first line treatment. 90% of the cases of kala azar are in Bihar, and children there have the burden of 50% of the loss of disability adjusted life years. ==References==