Abstract
Kala-azar is an endemic, disease in many parts of India. Traditionally diagnosis of this disease was based on demonstrating the parasites in various tissues like bone marrow or splenic aspirates. However, lack of high sensitivity of these methods led to the use of various immunodiagnostic methods in the diagnosis of kala-azar. Antigen detection and polymerase chain reaction to detect parasitic DNA have been found to be useful in patients with an underlying immunosuppressive disease like AIDS. For treating kala-azar, pentavalent antimonial compounds are still the first-line agents. However, due to increasing resistance to this agent, many patients at present requie other drugs including amphotericin B and pentamidine. Toxic effects of these second-line agents have led to development of drug dellvery systems like liposomal amphotericin B, which has shown uniform efficacy in clinical trials. Combining stibogluconate with either paromomycin or interferon-γ has also been shown to be useful in many patients with drug-resistant kala-azar.
Similar content being viewed by others
References
Kager PA. Visceral lesihmaniasis.Curr Opinions Infect Dis 1988; 1: 700–703.
Allain DS, Kagan IG. A direct agglutination test for leishmaniasis.Am J Trop Med Hyg 1975; 24: 232–236.
Harith AE, Kolk AH, Leewenburg Jet al. Improvement of a direct agglutination test for field studies of visceral leishmaniasis.J Clin Immunol 1988; 26: 1321–1325.
Singla N, Singh S, Sunder S, Vinayak VK. Evaluation of the direct agglutination test as an immunodiagnostic tool for kalaazar in India.Trans R Soc Trop Med Hyg 1993; 87: 276–279.
Singh S, Gilman-Sachs A, Chang KP, Reed SG. Diagnostic and prognostic value of k39 recombinant antigen in Indian leishmaniasis.J Parasitol 1995; 81: 1000–1003.
Sinha R, Sehgal S. Comparative evaluation of serological tests in Indian kalaazar.J Trop Med Hyg 1994;97: 334–340.
Jha TK, Thakur CPN, Singh IJ, Jha S. Direct agglutination test for early diagnosis of Indian visceral leishmaniasis.J Assoc Physicians India 1996; 44: 606–608.
Chaudhry A, Guru PY, Saxena RP, Tandon A, Saxena KC. Enzyme linked immunosorbent assay in the diagnosis of kalaazar in Bhadohi (Varanasi), India.Trans R Soc Trop Med Hyg 1990; 84: 363–366.
Vinayak VK, Mahajan D, Sobti RC, Singla N, Sunder S. Anti-66 kDa anti-leishmanial antibodies as specific immunodiganostic probe for vsiceral leishmaniasis.Indian J Med Res 1994; 99: 109–114.
Pappas MG, Hajkowski R, Hockmeyer WT. Standardization of the Dot enzyme-linked immunosorbent assay (Dot-ELISA) for human visceral leishmaniasis.Am J Trop Med Hyg 1993; 33: 1105–1111.
Gupta S, Srivastava JK, Pal Aet al. Direct agglutination test and Dot-ELISA in the serodiagnosis of visceral leishmaniasis (kala-azar)—a comparative study.Serodiag Immunother Infect Dis 1994; 6: 154–158.
Agarwal M, Jain A, Tewari V. Comparative evaluation of serological tests for diagnosis of visceral leishmaniasis.Indian J Exp Biol 1996; 34: 734–738.
Sinha R, Arora SK, Sehgal S. A sensitive ELISA for detection of circulating antigens in kala-azar patients.Indian J Med Res 1988; 88: 138–140.
Senaldi G, Xiao-su H, Hoessli DC, Bordier C. Serological diagnosis of visceral leishmaniasis by dot-enzyme immunoassay for the detection of aLeishmania donovani-related circulating antigen.J Immunol Medhods 1996; 193: 9–15.
de-Colmenares M, Portus M, Rier C,et al. Detection of 72–75 kD and 123 kD fractions of Leishmania antigen in urine of patients with visceral leishmaniasis. AmJ Trop Med Parasitol 1995; 52: 427–428.
Piarroux R, Gambarelli F, Dumon H,et al. Comparison of PCR with direct examination of bone marrow aspiration, myeloculture and serology for diagnosis of visceral leishmaniasis in immunocompromised patients.J Clin Microbiol 1994; 32: 746–749.
Sharma V, Chatterjee M, Mandal C, Sen S, Basu D. Rapid diagnosis of Indian visceral leishmaniasis using achatininH, a 9-O-acetylated sialic acid binding lectin.Am J Trop Med Hyg 1998; 58: 551–554.
Aggarwal P, Wali JP. Profile of kala-azar in north India.Asia Pacific J Pub Health 1991; 5: 90–93.
Sunder S, Rosenkaimer F, Murray HW. Immunochemotherapy for a systemic intracellular infection. Accelerated response using interferon-gamma in visceral leishmaniasis.J Infect Dis 1995; 171: 992–996.
Herwaldt BL, Berman JD. Recommendations for treating leishmaniasis with sodium stibogluconate (pentosam) and review of pertinent clinical studies.Am J Trop Med Hyg 1992; 46: 296–306.
Davidson RN, Croft SL Scott A, Maini M, Moody AH, Bryceson ADM. Liposomal amphotericin B in drug-resistant visceral leishmaniasis.Lancet 1991; 337: 1061–1062.
Dietze R, Milan EP, Berman JD,et al. Treatment of Brazilian kala-azar with a short course Amphocil (amphotericin B cholesterol dispersion)Clin Infect Dis 1993; 17: 981–986.
Sunder S, Murray HW. Cure of antimonyunresponsive Indian visceral leishmaniasis with liposomal amphotericin B lipid complex.J Infect Dis 1996; 173: 762–765.
Thakur CP, Pandey AK, Sinha GP, Roy S, Behbehni K, Olliaro P. Comparison of three treatment regimens with liposomal amphotericin B (AmBisome®) for visceral Iesihmaniasis in India: a randomized dose-finding study.Trans R Soc Trop Med Hyg 1996; 90: 319–322.
Thakur CP, Bhowmick S, Dolfi L, Olliaro P. Aminosidine plus sodium stibogluconate for the treatment of Indian kalaazar: a randomized dose-finding clinical trial.Trans R Soc Trop Med Hyg 1995; 89: 219–223.
Wali JP, Aggarwal P, Gupta U, Saluja S, Singh S. Ketoconazole in treatment of visceral leishmaniasis.Lancet 1990; 330: 810–811.
Wali JP, Aggarwal P, Nandy A,et al Efficacy of sodium antimony gluconate and ketoconazole in the treatment of kalaazar—A comparative study.J Comm Dis 1997; 29: 73–81.
Sunder S, Rosenkaimer F, Murray HW. Successful treatment of refractory visceral leishmaniasis in India using antimony plus interferon-gamme.J Infect Dis 1994; 70: 659–662.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Aggarwal, P., Handa, R., Singh, S. et al. Kala-azar-new developments in diagnosis and treatment. Indian J Pediatr 66, 63–71 (1999). https://doi.org/10.1007/BF02752355
Issue Date:
DOI: https://doi.org/10.1007/BF02752355