Kala azar: effective treatment for a little known disease now introduced in Georgia
August 29, 2011
It may not be a widely known fact that cases of the neglected tropical disease, kala azar, have increased over recent years in the Caucasus country of Georgia. Médecins Sans Frontières (MSF), which has a long history working in the country, primarily in the provision of treatment for tuberculosis, has just begun a project addressing this issue in the capital, Tbilisi. Since July, in collaboration with the Georgian Ministry of Health and the Parasitological Hospital in Tbilisi, MSF has helped introduce a new drug into the treatment protocol and is continuing to train staff for faster detection of this disease. Six patients have so far successfully completed the treatment, without the side effects and complications common with the previous drugs being supplied.
Fatal if left untreated, kala azar, transmitted by the bite of a sandfly, is a disease that mainly affects poor populations. However, it is possible to successfully treat patients and save lives if early diagnosis and effective treatment is provided on time. It is reported that Georgia has the third highest number of cases of the disease in the European region after Italy and Armenia.
Dr Hemant Pangtey, medical coordinator for MSF in Georgia, explains the background to this new project.
What is the current situation with kala azar in Georgia?
It has been well-reported that cases of kala azar are increasing in Georgia. Currently, the majority of cases are being reported from urban areas such as Tbilisi and Kakhiti, in the east of the country. Out of all of the patients registered at the Parasitological Hospital each year, approximately 70- 80 percent are children.
On average over the past three years, the hospital in Tbilisi was seeing between 110 and 150 cases per year. In relation to Georgia’s population of four million, this is not such a high figure. However, we suspect that this may not reflect the real number. Case detection is not as high as it could be as the diagnosis involves bone marrow examination, which is quite invasive for the patient. We hope that the introduction of the rapid test, which is much easier to use, will improve this issue and we can see patients who may otherwise not be seeking treatment.
What do you believe the reason is for the overall increase in cases?
We cannot categorically say why patient numbers have increased in Georgia. But some possible reasons include increased deforestation, and a shift of the population from rural to urban areas. Different species of the parasite causing the disease are transmitted by the phlebotomine sandfly. Both animals and humans can act as the reservoir for this parasite, and we know there has been a rise in the number of street dogs in Tbilisi over the past years.
Why did MSF decide to assist in this project and what will be our role in the treatment of the disease?
MSF saw that there is a real need in Georgia for a shorter, more effective treatment for patients, with fewer side effects. We are working closely alongside the Ministry of Health to introduce a new drug, AmBisome, into the national treatment protocol. It is probably the most effective kala azar drug that we have available today, and has proven to cure more than 95 percent of patients. A patient taking this drug will finish treatment in just ten days, with a series of four injections, as opposed to thirty days of treatment using the drug that was administered previously. The other advantage of AmBisome is that it is more effective in treating patients who are HIV positive.
As malnutrition is common in kala azar patients, particularly children, MSF will also be providing therapeutic food to patients who require it.
How can we ensure that we are accessing people outside of the bigger urban areas?
Currently, treatment is only available in Tbilisi, so we are concerned that some people might not be reaching the hospital, and if they do make it, many may be too late. From September, alongside the Parasitological Hospital team and a Ministry of Health representative, an MSF team will focus on assessing outlying areas and training the health care staff to detect and screen the disease. Additionally, the introduction of the rapid test will make the diagnosis of the disease much easier, less expensive and much less traumatic. Our plan is that once this outreach training is complete, diagnosis and treatment will be accessible to many more people in several other areas.
KALA AZAR FACTS
- Kala azar is spread though the bite of a sandfly.
- It is fatal if left untreated, but death can be avoided with timely treatment.
- Symptoms include fever, weight loss, anaemia, enlargement of the spleen and liver and immune system depression.
- Kala azar is the second largest cause of parasitic death worldwide.
- It affects around half a million people per year around the globe.
- Ninety percent of cases occur in Sudan, India, Brazil and Bangladesh.
MSF has been working in Georgia since 1993. Teams are also currently supporting the national tuberculosis program in Abkhazia, a breakaway region in northwest Georgia, as well as providing general healthcare to this extremely vulnerable population.