Giving the drug to asymptomatic cases of Kala-zar can be dicey though diagnostic performance and affordability of the rK39 dipstick are very good
So far the strategy with Kala-zar is that treat all symptomatics after confirmation with rk39 rapid diagnostic test besides vector control. Our contention is that since asymptomatic patients can become symptomatic later and can also become reservoirs of infection, so do mass screening with rapid and easy test rk39 and treat all positives with miltefosine ( a new orally bioavailable drug) as discussed in the rapid response published on 11th April, 2015(1).
We further thought that If the sensitivity and specificity of the test is high and logistics is not an issue, the strategy can be contemplated.. The sensitivity and specificity of rk39 are very high and cost is pretty low. One can read in the paper2. Another hitch that has cropped up while musing over earlier response which we would like to share with others as well, is that miltefosine (the oral drug available) is not cheap and resistance can develop in case of non-compliant and irregular treatment which has to be supervised strictly.
Rapid Response:
Giving the drug to asymptomatic cases of Kala-zar can be dicey though diagnostic performance and affordability of the rK39 dipstick are very good
So far the strategy with Kala-zar is that treat all symptomatics after confirmation with rk39 rapid diagnostic test besides vector control. Our contention is that since asymptomatic patients can become symptomatic later and can also become reservoirs of infection, so do mass screening with rapid and easy test rk39 and treat all positives with miltefosine ( a new orally bioavailable drug) as discussed in the rapid response published on 11th April, 2015(1).
We further thought that If the sensitivity and specificity of the test is high and logistics is not an issue, the strategy can be contemplated.. The sensitivity and specificity of rk39 are very high and cost is pretty low. One can read in the paper2. Another hitch that has cropped up while musing over earlier response which we would like to share with others as well, is that miltefosine (the oral drug available) is not cheap and resistance can develop in case of non-compliant and irregular treatment which has to be supervised strictly.
References:
1. http://www.bmj.com/content/333/7571/723/rr..
2. BMJ 2006;333:723
Competing interests: No competing interests