NVBDCP Guidelines On Diagnosis And Treatment Of Kala-Azar

Can you please suggest me Guidelines On Diagnosis And Treatment Of Kala-Azar fixed by National Vector Borne Disease Control Programme?

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Don’t worry I will tell you National Vector Borne Disease Control Programme, Guidelines On Diagnosis And Treatment Of Kala-Azar.

Diagnosis
Clinical:
A case of fever of more than 2 weeks duration not responding to antimalarials and antibiotics.

Clinical laboratory findings may include anaemia, progressive leucopenia thrombocytopenia and hypergammaglobulinemia

Laboratory:
Serology tests: Variety of tests are available for diagnosis of Kala-azar. The most commonly used tests based on relative sensitivity; specificity and operationally feasibility include Direct Agglutination Test (DAT), rk39 dipstick and ELISA.

Aldehyde Test is commonly used but it is a non-specific test. IgM detecting tests are under development and not available for field use.

Parasite demonstration in bone marrow/spleen/lymphnode aspiration or in culture medium is the confirmatory diagnosis.

Though spleen aspiration has the highest sensitivity and specificity (considered gold standard) but a skilled professional with appropriate precaustions can perform it only at a good hospital facility.

Differential Diagnosis:
Typhoid
Miliary tuberculosis
Malaria
Brucellosis
Amoebic liver abscess
Infectious mononucleosis
Lymphoma, Leukemia
Tropical splenomegaly
Portal hypertension

Treatment
Kala-azar Drugs available in India
Sodium Stibogluconate (indigenous manufacture, registered for use & sale)
Pentamidine Isethionate: (imported, registered for use) Amphotericin B: (indigenous manufacture, registered for use and sale)

Liposomal Amphotericin B: (indigenous manufacture & import, registered for use and sale) Miltefosine (imported/ registered for use & sale)

Drug Policy under Kala-azar Elimination Programme as per recommendations of Expert Committee (2000) – (This drug policy is under review)

First Line Drugs
A. Short Term
Areas with SSG sensitivity >90%
SSG IM/IV 20mg/kg/day X 30 days

Areas with SSG sensitivity <90%
Amphotericin B 1mg/kg b.w. IV infusion daily or alternate day for 15-20 infusions. Dose can be increased in patients with incomplete response with 30 injections

B. Long Term
Areas with high level of SSG resistance (>20%)
Miltefosine 100 mg daily x 4 weeks (after phase III studies completed with proven safety & efficacy)

Areas with SSG sensitivity >80%
SSG IM/IV 20mg/kg/day X 30 days
Miltefosine 100 mg daily x 4 weeks (after phase III studies completed with proven safety & efficacy)

Second Line Drugs
A. SSG Failures
Amphotericin B 1mg/kg b.w. IV infusion daily or alternate day for 15-20 infusions. Dose can be increased in patients with incomplete response with 30 injections

B. SSG and Miltefosine Failures
Liposomal Amphotericin B (when final results are available with proven efficacy and safety)

Treatment of PKDL
SSG in usual dosages for KA could be given up to 120 days
Repeated 3-4 courses of Amphotericin B can be given in patients failing SSG treatment

Address:-
National Vector Borne Disease Control Programme
22, SHAM NATH MARG, DELHI - 110054

Phone:-
91–011–23967745, 23967780