# Filariasis, Dengue, Chikungunya and Kala-azar for NEET PG PSM: MDA Doses, Dengue Phases and Tests, Kala-azar Treatment Source: https://tracknation.in/story/filariasis-dengue-chikungunya-and-kala-azar-for-neet-pg-psm-mda-doses-dengue-phases-and-tests-kala-azar-treatment (TrackNation β€” free UPSC notes with PYQs) > NEET PG Community Medicine: lymphatic filariasis (DA and IDA doses, who is excluded, the 2027 target), dengue 2023 guidelines (phases, warning signs, NS1 or IgM, no NSAIDs, no prophylactic platelets), chikungunya, and kala-azar (case definition, single-dose liposomal amphotericin B, PKDL, elimination target), from NCVBDC documents, with a diagram, hooks, MCQs and cards. ## Start Here 🎯 **Exam priority: Medium–high.** *Dengue management and the filariasis MDA are the most tested. Malaria and JE are in the previous article.* CBME mapping: **CM 3.6, CM 3.7, CM 8**. | **Disease** | **Agent** | **Vector in India** | **Remember** | | **Lymphatic filariasis** | *Wuchereria bancrofti* (99.4%) | *Culex quinquefasciatus* | Microfilariae are nocturnal: take blood at night | | **Dengue** | Dengue virus, 4 serotypes | *Aedes aegypti*, also *Ae. albopictus* | Secondary infection carries the higher risk of severe disease | | **Chikungunya** | Alphavirus, family Togaviridae | *Aedes aegypti* | Incapacitating joint pain | | **Kala-azar** | *Leishmania donovani* | Sand fly, *Phlebotomus argentipes* | Fever over 2 weeks with splenomegaly | ## Lymphatic Filariasis - **Burden**: 345 endemic districts and about 740 million people at risk (2023). - **Elimination threshold**: microfilaria rate below **1%** or antigenaemia rate below **2%**. India aims to reach this by the end of **2027**. - **Adult worms** live 6–7 years. **Chronic disease**: lymphoedema and hydrocele. - **Night blood survey**: microfilariae are nocturnal, so sample at night. Antigen is tested with a filariasis test strip. **Mass drug administration (MDA)** treats everyone eligible in an area with Mf rate above 1%, whether infected or not. India's enhanced five-pronged strategy (2023) runs it in mission mode with **directly observed consumption**, aiming for over **90%** coverage. - **DA**: DEC + albendazole, yearly for **5–6 years**. - **IDA**: ivermectin + DEC + albendazole, yearly for **2–3 years**. Ivermectin is dosed by **height** with a dose pole. | **Age** | **DEC (100 mg tablets)** | **Albendazole** | | 2–5 years | 100 mg (1 tablet) | 400 mg | | 6–14 years | 200 mg (2 tablets) | 400 mg | | 15 years and above | 300 mg (3 tablets) | 400 mg | | **Drug** | **Do not give to** | | DEC and albendazole | Children under 2, pregnant women, the seriously ill | | Ivermectin | Children under 5 or under 90 cm tall, pregnant women, mothers within one week of delivery, active serious illness | People on regular medicines for uncomplicated hypertension, diabetes or TB can take MDA drugs. **Stopping MDA**: a Transmission Assessment Survey tests school children in classes 4–8. **Morbidity care**: lymphoedema needs washing, treating entry lesions, elevating the foot, exercise, proper footwear and managing acute attacks. Hydrocele is treated surgically; over 2.13 lakh hydrocelectomies have been done under the programme. ## Dengue *The dangerous window opens as fever settles. NS1 suits the first 5 days and IgM after that.* - **Virus**: four serotypes, DENV-1 to 4. Infection gives only a few months of cross-protection against other serotypes, and a second infection carries the higher risk of severe disease. - **Vector**: *Aedes aegypti*, which lays eggs singly on damp surfaces just above the water line. - **Clinical description**: fever of 2–7 days with two or more of headache, retro-orbital pain, myalgia, arthralgia, rash, bleeding, low platelets or white cells, or warning signs. - **Tests**: NS1 for day 1–5, IgM after 5 days. A rapid test positive counts only as **probable** dengue. - **Numbers**: 2,33,519 cases and 297 deaths in 2024; 1,21,824 cases and 131 deaths in 2025. **Warning signs**: persistent vomiting; abdominal pain and tenderness; lethargy or restlessness; bleeding; fainting; ascites or pleural effusion; liver over 2 cm; rising haematocrit with a rapid fall in platelets. | **Group** | **Meaning** | **Who** | | **A** (mild) | No warning signs | Fever with non-specific symptoms; platelets and haematocrit usually normal | | **B** (moderate) | Warning signs, or high-risk factors | B1 warning signs; B2 comorbidities and other risks | | **C** (severe) | Shock, severe bleeding or organ dysfunction | Severe plasma leakage with shock or respiratory distress | **Treatment rules** - **No specific antiviral.** Paracetamol for fever, up to 4 g a day in adults. **Avoid aspirin and NSAIDs**, and avoid IM injections. - Oral fluids for mild disease; **crystalloids** are the preferred IV fluid. - **No prophylactic platelet transfusion.** - Too much or too rapid IV fluid causes overload, so review often. ## Chikungunya - First isolated in Tanzania in 1953. An Alphavirus of the family Togaviridae. - **Suspected case**: acute fever and arthralgia or arthritis, with or without rash. - **Confirmed by** IgM ELISA, virus isolation, or viral RNA by RT-PCR. - **Telling it from dengue**: severe, incapacitating joint pain, and severe thrombocytopenia is rare. - **Pain relief**: paracetamol first. Avoid NSAIDs in pregnancy, and in children in the first 14 days of illness. ## Kala-azar - **Where**: four endemic states: Bihar, Jharkhand, West Bengal and Uttar Pradesh. It is notifiable in all of them. - **Incubation**: four months to one year in India. - **Suspect case**: fever over **2 weeks** with splenomegaly and hepatomegaly, not responding to antimalarials and antibiotics, in someone from an endemic area. - **Tests**: rapid diagnostic test for screening. It can stay positive for a long time, so **do not use it in someone with past kala-azar**. - **PKDL**: hypopigmented or erythematous macules that may become papular or nodular, especially on the face. Easily mistaken for leprosy. These patients are a **reservoir**, which is why they matter for elimination. - **Elimination target**: below **1 case per 10,000** population at **block** level. - **Vector control**: indoor residual spraying with synthetic pyrethroid, which replaced DDT from 2015 because of resistance. | **Use** | **Regimen** | | Kala-azar, first choice | **Liposomal amphotericin B, 10 mg/kg as a single dose** | | Next options | Miltefosine for 28 days; amphotericin B 15 alternate-day injections; miltefosine with paromomycin | | PKDL, first choice | **Miltefosine 100 mg a day for 12 weeks** | ## Traps the Examiner Sets - Ivermectin goes by height; DEC goes by age. DEC is not for children under 2, ivermectin not for under 5. - IDA is 2–3 years; DA is 5–6 years. - Dengue: NS1 early, IgM late. Rapid test positive is only probable. - Platelet count alone does not call for platelet transfusion. - Kala-azar elimination is measured at block level, not district level. - First choice differs: kala-azar is liposomal amphotericin B, PKDL is miltefosine. ## Memory Hooks & Shortcuts *Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.* - 🧠 **1-2-3 by age** β€” DEC tablets: 1 for ages 2–5, 2 for ages 6–14, 3 for 15 and above - 🧠 **Tall for Ivermectin** β€” ivermectin is dosed by height and starts at 90 cm - 🧠 **IDA is faster: 2–3 versus 5–6** β€” triple-drug rounds needed compared with DA - 🧠 **NS1 early, IgM late, split at day 5** β€” dengue test choice - 🧠 **Falling fever, rising danger** β€” the critical phase begins as the fever settles - 🧠 **Spleen plus two weeks** β€” the kala-azar suspect case - 🧠 **10 once, or 100 for 12** β€” L-AmB 10 mg/kg once for kala-azar; miltefosine 100 mg for 12 weeks for PKDL ## Rapid-Revision Cards - 345 endemic districts; about 740 million at risk. - Mf rate <1% or antigenaemia <2%; India's target end of 2027. - W. bancrofti (99.4%); Culex quinquefasciatus. - 2–5 y 100 mg; 6–14 y 200 mg; 15+ y 300 mg. - 400 mg. - By height, using a dose pole. - DA 5–6 years; IDA 2–3 years. - Over 90%, with directly observed consumption. - 2 years. - 5 years or 90 cm. - Wash, treat entry lesions, elevate, exercise, footwear, treat acute attacks. - Four; DENV-1 to 4. - Aedes aegypti; also Ae. albopictus. - 2–7 days. - After day 3–4; lasts 24–48 hours. - NS1 days 1–5; IgM after day 5. - Probable, not confirmed. - Paracetamol; avoid aspirin and NSAIDs. - Not recommended. - A mild, B warning signs or risk, C severe. - Alphavirus, Togaviridae; Aedes; disabling joint pain. - Phlebotomus argentipes. - Fever >2 weeks with spleen and liver enlargement in an endemic area. - Liposomal amphotericin B 10 mg/kg once. - Miltefosine 100 mg a day for 12 weeks. - <1 per 10,000 at block level. - Bihar, Jharkhand, West Bengal, Uttar Pradesh. ## Sources *Facts in this article were checked against these documents.* - Revised Guideline on Elimination of Lymphatic Filariasis β€” NCVBDC, MoHFW, 2024 (link) - National Guidelines for Clinical Management of Dengue Fever β€” NCVBDC, MoHFW, 2023 (link) - National Guidelines for Clinical Management of Chikungunya Fever β€” NCVBDC, MoHFW, 2023 (link) - Dengue cases and deaths in the country, 2021–2026 (provisional to 30 April 2026) β€” NCVBDC, 2026 (link) - Operational Guidelines on Kala-azar (Visceral Leishmaniasis) Elimination β€” NVBDCP, MoHFW, 2015 (link) - Operational definitions in the kala-azar elimination programme β€” NVBDCP, MoHFW, 2021 (link) - Decentralization of procurement of synthetic pyrethroid under the kala-azar programme β€” NCVBDC, 27 March 2026 (link) ## Test Yourself: Practice Questions Twenty-five questions in NEET PG style. ## Practice Questions (NEET PG pattern) *Original questions written in the style of the exam: +4 for a correct answer, βˆ’1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.* **Q1.** During a filariasis MDA round, a healthy 4-year-old girl 100 cm tall comes for tablets under the IDA regimen. She should receive - (a) DEC and albendazole, but not ivermectin - (b) albendazole alone - (c) all three drugs - (d) no drugs **Answer: (a)** β€” Ivermectin is not for children under 5 years or under 90 cm. She is over 2, so DEC and albendazole are given. **Q2.** The DEC dose for a 10-year-old in MDA is - (a) 100 mg - (b) 6 mg/kg - (c) 200 mg - (d) 300 mg **Answer: (c)** β€” 2–5 years 100 mg, 6–14 years 200 mg, 15 and above 300 mg. **Q3.** In the IDA regimen, the dose of ivermectin is decided by - (a) weight measured on a scale - (b) microfilaria count - (c) age - (d) height **Answer: (d)** β€” Ivermectin is given by height, using a colour-coded dose pole. **Q4.** How many annual rounds of IDA are planned, compared with DA? - (a) 1 year against 3 years - (b) 2–3 years against 5–6 years - (c) 10 years for both - (d) 5–6 years against 2–3 years **Answer: (b)** β€” The annual dose is repeated for 5–6 years for DA and 2–3 years for IDA, aiming at over 90% compliance. **Q5.** Filariasis ceases to be a public health problem when the microfilaria rate falls below - (a) 0.1% - (b) 10% - (c) 1% - (d) 5% **Answer: (c)** β€” Microfilaria rate below 1% or antigenaemia rate below 2%. **Q6.** The vector responsible for most lymphatic filariasis in India is - (a) Mansonia annulifera - (b) Culex quinquefasciatus - (c) Aedes aegypti - (d) Anopheles stephensi **Answer: (b)** β€” W. bancrofti transmitted by Culex quinquefasciatus accounts for 99.4% of the problem. **Q7.** A night blood survey is done for filariasis because - (a) the vector is only active at dawn - (b) microfilariae show nocturnal periodicity - (c) adult worms only feed at night - (d) antigen appears only at night **Answer: (b)** β€” Microfilariae exhibit nocturnal periodicity. **Q8.** A patient with long-standing lymphoedema asks how to reduce acute attacks. The most useful advice is - (a) lifelong oral antibiotics in every case - (b) bed rest and avoiding footwear - (c) surgical excision of the limb skin - (d) regular washing and care of entry lesions **Answer: (d)** β€” Washing, treating entry lesions, elevation, exercise and footwear form the package; bacterial entry drives acute attacks. **Q9.** A patient has had dengue-like fever for 2 days. The best test to confirm infection is - (a) IgG ELISA - (b) IgM ELISA - (c) Blood culture - (d) NS1 antigen **Answer: (d)** β€” NS1 for samples collected from day 1 to 5, IgM after 5 days. **Q10.** A patient has fever for 7 days. Which test is most suitable? - (a) IgM ELISA - (b) Peripheral smear for parasites - (c) NS1 antigen - (d) Widal test **Answer: (a)** β€” After day 5, IgM is the recommended test. **Q11.** An RDT for dengue NS1 is positive in a febrile patient. Under the guideline this is a - (a) probable case - (b) confirmed case - (c) false positive - (d) suspected case only if IgG is positive **Answer: (a)** β€” A positive RDT counts as probable because of poor sensitivity and specificity of current RDTs. **Q12.** A dengue patient's fever settled on day 4, but she now has persistent vomiting, abdominal tenderness and a rising haematocrit with falling platelets. This is - (a) dengue with warning signs (Group B) - (b) recovery phase - (c) severe dengue with shock (Group C) - (d) dengue without warning signs (Group A) **Answer: (a)** β€” These are warning signs of the critical phase. There is no shock, severe bleeding or organ dysfunction yet. **Q13.** The critical phase of dengue usually starts - (a) only after the fever returns - (b) after 2 weeks - (c) after the 3rd or 4th day of fever and lasts 24 to 48 hours - (d) on day 1 and lasts 7 days **Answer: (c)** β€” It begins after the 3rd or 4th day of fever and may last about 24 to 48 hours. **Q14.** A man with dengue has a platelet count of 18,000/mmΒ³, no bleeding and stable vitals. The next step is - (a) continue monitoring without platelet transfusion - (b) give a prophylactic platelet transfusion - (c) give IM vitamin K - (d) give fresh frozen plasma **Answer: (a)** β€” Platelet transfusion is not recommended for thrombocytopenia as prophylaxis. **Q15.** Which drug should be avoided for fever in dengue? - (a) Ibuprofen - (b) Ondansetron - (c) Paracetamol - (d) Oral rehydration solution **Answer: (a)** β€” Aspirin and NSAIDs must be avoided because of the risk of mucosal bleeds; use paracetamol. **Q16.** Severe dengue includes all EXCEPT - (a) shock from plasma leakage - (b) severe bleeding - (c) leucopenia alone - (d) severe organ dysfunction **Answer: (c)** β€” Severe dengue means severe plasma leakage, severe bleeding or organ dysfunction. Leucopenia is common in mild disease. **Q17.** Dengue serotypes are - (a) two - (b) six - (c) four: DENV-1 to DENV-4 - (d) one with many subtypes only **Answer: (c)** β€” DENV-1, 2, 3 and 4. Immunity gives cross-protection for only a few months. **Q18.** A patient has fever with severe, disabling joint pain in both wrists and ankles. Platelets are normal. The likely infection, spread by Aedes, is - (a) Japanese encephalitis - (b) chikungunya - (c) kala-azar - (d) dengue haemorrhagic fever **Answer: (b)** β€” Incapacitating arthralgia marks chikungunya; severe thrombocytopenia is rare. **Q19.** Chikungunya virus belongs to the family - (a) Bunyaviridae - (b) Togaviridae - (c) Flaviviridae - (d) Reoviridae **Answer: (b)** β€” Genus Alphavirus, family Togaviridae. **Q20.** A patient from Bihar has fever for 4 weeks, splenomegaly and hepatomegaly, not responding to antimalarials or antibiotics. The most likely diagnosis is - (a) typhoid - (b) chikungunya - (c) kala-azar - (d) dengue **Answer: (c)** β€” This fits the suspect case definition: fever over 2 weeks with splenomegaly and hepatomegaly in an endemic area. **Q21.** The first drug of choice for kala-azar in India is - (a) miltefosine for 12 weeks - (b) sodium stibogluconate for 30 days - (c) pentamidine - (d) liposomal amphotericin B, 10 mg/kg single dose **Answer: (d)** β€” Single-dose liposomal amphotericin B is first choice; miltefosine for 28 days follows. **Q22.** The first drug of choice for PKDL is - (a) liposomal amphotericin B, single dose - (b) miltefosine 100 mg daily for 12 weeks - (c) chloroquine - (d) dapsone **Answer: (b)** β€” Miltefosine 100 mg orally per day for 12 weeks. **Q23.** Kala-azar elimination is defined as an annual incidence of less than - (a) 10 cases per lakh at state level - (b) 1 case per 1,000 at district level - (c) 1 case per 10,000 population at block level - (d) zero cases nationally **Answer: (c)** β€” Below one case per 10,000 population at block level. **Q24.** A man treated for kala-azar 2 years ago now has fever and splenomegaly. Why is the rapid test unhelpful? - (a) It cannot be used in men - (b) It may remain positive for a long time - (c) It only detects PKDL - (d) It works only in children **Answer: (b)** β€” In suspected cases with past kala-azar, the RDT should not be used; it may remain positive for a long period. **Q25.** Why does the programme search actively for PKDL cases? - (a) They need ICU care - (b) They spread by droplets - (c) They are a reservoir for transmission - (d) They are highly fatal **Answer: (c)** β€” PKDL cases serve as a reservoir for disease transmission during the inter-epidemic period. ### Active Recall From memory: give the MDA drugs, doses and exclusions for filariasis and the elimination threshold; the dengue phases, warning signs, test timing and treatment rules; what sets chikungunya apart; and the kala-azar suspect case, treatment, PKDL treatment and elimination target.