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 The wide gap between the number of reported
and estimated cases constrains planning of elimination.
At present, diagnosis and treatment have been
limited to large hospitals. Patients often seek treatment from private
doctors or even quacks, who provide expensive,
incomplete or inappropriate treatment that favours continued transmission of
the disease.
Currently
used drugs like sodium stiboglconate show variable efficacy and are toxic.
PKDL patients with only skin signs resulting
from delayed or incomplete treatment are reservoirs of infection responsible
for continued transmission. These patients are difficult to diagnose and
treat.
The threat of HIV/AIDS and kala azar co-infection
is increasing. If HIV/AIDS epidemic spreads to the general population where
kala azar is endemic, it may have disastrous consequences.
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