Sundar Shyam, Chakravarty Jaya
Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India.
Natl Med J India. 2012 Mar-Apr;25(2):85-9.
In India, about 100 000 cases of visceral leishmaniasis (VL) or kala-azar are estimated to occur annually, 90% of which occur in the state of Bihar. Currently, antibody-based tests such as the rK39-based immunochromatographic strip test and the direct agglutination test (DAT) are widely used for the diagnosis of VL. However, their major drawback is continued positivity both long after cure and in a high proportion of individuals living in endemic areas. Thus, antibody-based tests must always be used in combination with a standardized clinical case definition for VL. There have been many breakthroughs in the past decade in the treatment of kala-azar in India, such as approval of oral miltefosine and paromomycin, single-dose treatment with liposomal amphotericin B and multidrug treatment. Encouraged by these advances, an ambitious VL elimination programme was launched with the aim to eliminate VL as a public health problem in India, Nepal and Bangladesh by 2015. Early diagnosis, complete treatment of cases, integrated vector management, effective disease surveillance, and clinical and operational research should be the five key components of the strategy to achieve this goal.
在印度，估计每年发生约10万例内脏利什曼病（VL）或黑热病，其中90%发生在比哈尔邦。目前，基于抗体的检测，如基于rK39的免疫层析试纸条检测和直接凝集试验（DAT），被广泛用于VL的诊断。然而，它们的主要缺点是在治愈后很长时间以及在高比例的流行地区居民中持续呈阳性。因此，基于抗体的检测必须始终与VL的标准化临床病例定义结合使用。在过去十年中，印度在黑热病治疗方面取得了许多突破，如口服米替福新和巴龙霉素的获批、脂质体两性霉素B单剂量治疗以及多药治疗。受这些进展的鼓舞，一项雄心勃勃的VL消除计划启动，目标是到2015年在印度、尼泊尔和孟加拉国消除VL这一公共卫生问题。早期诊断、病例的彻底治疗、综合病媒管理、有效的疾病监测以及临床和运营研究应是实现这一目标战略的五个关键组成部分。
