Kala Azar in South Asia Current Status and Challenges Ahead
Therapeutic regimens for visceral leishmaniasis (also Kala-azar, Dum-dum fever or black fever), caused by parasitic protozoa of the Leishmania genus, evolve at a pace never seen before. Spread by tiny and abundant sand flies, the parasite infects internal
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T.K. Jha · E. Noiri Editors
Kala Azar in South Asia Current Status and Challenges Ahead
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Editors Dr. T.K. Jha, MRCP, DTM Kalazar Research Center Brahmpura 842003 Muzaffarpur India [email protected]
E. Noiri, MD, PhD The University of Tokyo 107. Lab Nephrology & Endocrinology University Hospital 7-3-1 Hongo Bunkyo Tokyo Japan 113-8655 [email protected]
ISBN 978-94-007-0276-9 e-ISBN 978-94-007-0277-6 DOI 10.1007/978-94-007-0277-6 Springer Dordrecht Heidelberg London New York © Springer Science+Business Media B.V. 2011 No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without written permission from the Publisher, with the exception of any material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)
Preface
One of the most important challenges for third world countries is to educate and support their inhabitants to maintain an independent and comfortable lifestyle. Difficult enough when there is no health problem, but life-threatening infectious diseases are more prevalent in the tropical zone than in more temperate climates. Compared to other tropical infectious diseases, patients with Visceral Leishmaniasis (VL) won’t visit the clinic until the disease developed for longer periods and therefore they are often in the advanced stages of the disease: the symptoms do not appear early and the disease process is subacute and does not greatly affect the physical wellbeing. The diagnosis of VL used to be extremely difficult for physicians, requiring a bone marrow biopsy, but the recent improvements made the diagnosis much easier and faster. When treating patients, the adherence to medication is always an issue for medical practice, even the western countries but especially so in the developing world. To cope with this and other issues, therapeutic patterns have to be developed and evaluated specifically for the endemic areas. During the next several years, the clinical approach to VL and to post kalaazar dermal Leishmaniasis in the Indian subcontinent and South-Asia will need to change. Standing at a turning point in VL medicine, we had the opportunity to organize the expert conference entitled “Consultative Meeting on Elimination of Kala-Azar from South Asia” in the late summer of 2009 in New Delhi, India under the support of Japanese Science Technology Agency. It is my great pleasure to share with you the latest knowledge in Visceral Leishmaniasis! Tokyo, Japan
Eisei NOIRI, MD, PhD
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Contents
Part I
Introduction into Kala-Azar
1 Geographical Distribution of Kala-Azar in South Asia . . . . . . Moazzem Hossain and Kazi M. Jamil
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2 Pathology and Mechanism of Disease in Kala-Azar and Post-kala-azar Dermal Leishmaniasis . . . . . . . . . . . . . Moazzem Hossain and Kazi M. Jamil
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