The World Health Organization (WHO) has introduced revised treatment guidelines for Visceral Leishmaniasis (VL), commonly known as Kala-azar, and post-kala-azar dermal leishmaniasis (PKDL) in East Africa and South-East Asia.

Kala-azar, transmitted by infected sandflies, is the second deadliest parasitic disease globally after malaria. It affects over 50,000 people annually across 80 endemic countries, though only a fraction of cases are reported.

New Treatment Recommendations

  • In East Africa, the WHO now advises a combination therapy of oral miltefosine with injectable paromomycin for both VL and PKDL patients.
  • This regimen lasts 14 days, requires only one injection, and significantly reduces toxicity compared to the previous 17-day treatment involving two injections of sodium stibogluconate (SSG).
  • SSG, previously the mainstay treatment, is associated with painful daily injections and severe side effects; the new guidelines mark the first WHO recommendation for an SSG-free regimen, although SSG remains an option for certain patients.
  • For South-East Asia, shorter combination therapies involving liposomal amphotericin B and miltefosine are recommended for PKDL.

Clinical Evidence and Impact

The updated guidelines are based on clinical trials conducted in Kenya's Kacheliba Sub-County Hospital and other sites in Uganda, Ethiopia, and South Sudan. These studies were led by the Drugs for Neglected Diseases initiative (DNDi) in collaboration with national health authorities.

Symptoms of Kala-azar include persistent high fever, weight loss, anaemia, and enlargement of the spleen and liver. Without prompt treatment, the disease can be fatal.

The new treatment protocols aim to simplify and shorten the therapy duration, reducing patient discomfort and toxicity while improving outcomes.

About Kala-azar

Leishmaniasis treatment varies depending on the disease form, patient immune status, parasite species, co-existing conditions, and region.