Weill Medical College of Cornell University

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Visceral Leishmaniasis in India: The Kala-Azar Medical Research and Treatment Center. Murray. In 1994, we established the Kala-Azar Medical Research Center (KAMRC) in rural India, in Bihar State (the epicenter of India�s visceral leishmaniasis epidemic), to test new treatments and develop new diagnostic and therapeutic approaches. Some of these new clinical approaches were the direct result of experimental work carried out in parallel in Leishmania-infected animals in our Weill-Cornell laboratory in New York City.

Visceral leishmaniasis (kala-azar) is a worldwide parasitic infection that involves the liver, spleen and bone marrow in children and adults. One-half of the world�s 500,000 new cases occur in India. The treatment trials work at KAMRC has been remarkably successful, and initially more than 35 separate clinical trials were carried out in over 5,000 children and adults. For injectible treatments, we defined the usefulness of combination immunochemotherapy, short-course cost-effective treatment, and single-dose therapy using liposomal amphotericin B (heretofore, 21-28 days had been the usual prior treatment duration). Equally important, we identified and tested miltefosine, the first effective oral therapy for this disease, representing, along with single-dose parenteral therapy, a second major breakthrough in treatment in kalaazar. In addition, we developed the concept of and tested short-course combination chemotherapy, using a single dose of a parenteral agent (liposomal amphotericin B) followed by 7 days of oral therapy (miltefosine). Separate results from a series of other trials have also demonstrated the sensitivity, specificity and clinical usefulness of rapid non-invasive diagnosis of kala-azar using fingerstick blood and the K39 antibody strip test. This reliable diagnostic method spares patients with kala-azar splenic or bone marrow aspiration.

• Murray . Leishmaniasis in the United States: treatment in 2012. Amer J Trop Med Hyg 2012;86:434-40.
• Murray HW, Berman JD, Davies CR, Saravia NG. Advances in leishmaniasis. Lancet 2005;366:1561-77.
• Sundar S, Chakravarty J, Agarwal D, Rai M, Murray HW. Single-dose liposomal amphotericin B for visceral leishmaniasis in India. N Engl J Med 2010;362:504-12.
• Sundar S, Chakravarty J, Rai VK, Agrawal N, Singh SP, Chauhan V, Murray HW. Amphotericin B treatment in Indian visceral leishmaniasis: response to 15 daily vs. alternate-day infusions. Clin Infect Dis 2007;45:556-61.
• Sundar S, Maurya R, Singh RK, Bharti K, Chakravarty J, Parekh A, Rai M, Kumar K, Murray HW. Rapid, noninvasive diagnosis in Indian visceral leishmaniasis: comparison of two strip formats in detection of anti-K39 antibody. J Clin Microbiol 2006;44:251-53.