Post kala azar dermal leishmaniasis in visceral leishmaniasis endemic communities in bihar, india. The term post kalaazar dermal leishmaniasis was coined for the first time by acton and. Postkalaazar dermal leishmaniasis pkdl is a cutaneous complication of visceral leishmaniasis vl which usually appears after treatment of a vl episode. Post kalaazar dermal leishmaniasis pkdl is a complication of treatment for patients with visceral leishmaniasis vl caused by leishmania donovani and results in the presence of multiple hypopigmented papules or nodules on the skin. Relevant articles from the authors personal files were identified. Using focused pharmacovigilance for ensuring patient.
Visceral leishmaniasis vl, kalaazar is most common in asia india. Vl, also known as kalaazar, is caused by species of leishmania that are transmitted by the bite of a female sandfly, and it is estimated that 200 million people are at risk for the yearly 500 000 cases. If a relationship between treatment for vl and development of pkdl and vlr is there, and. Phase 4 trial of miltefosine for the treatment of indian visceral leishmaniasis. The test is positive in african kala azar but not in indian and mediterranean kalaazar and post kala azar dermal leishmaniasis. Identification of postkalaazar dermal leishmaniasis pkdl is important due to the long and toxic treatment and the fact that pkdl patients may serve as a reservoir for visceral leishmaniasis vl. Wed like to understand how you use our websites in order to improve them. Diagnosis of vl in dogs in latin america and mediterranean countries remains confusing because of rampant asymptomatic infections and elevated antibodies against leishmania spp. Bhattacharya sk, sinha pk, sunder s, thakur cp, jha tk, pandey k, et al. Pkdl is confined mainly to india and its adjoining countries, such as bangladesh and nepal, and it is also seen in sudan and kenya. Pkdl patients are considered a potential reservoir for anthroponotic leishmaniasis owing to the high number of.
They manifest as hypopigmented skin lesions such as. Untreated cases of pkdl are considered to be the sole reservoir to house and disseminate the causative parasite ld in the absence of zoonotic transmission 1. We summarized the published literature about the accuracy of diagnostic tests for pkdl. Because of its possible role in transmission it is considered a public health problem in vl endemic areas.
The immunology of postkalaazar dermal leishmaniasis. This study compared xenodiagnosis with quantitative pcr in skin biopsies from three patients with maculopapular or nodular postkalaazar dermal leishmaniasis pkdl. Post kalaazar dermal leishmaniasis pkdl is a wellrecognized compli cation of visceral leishmaniasis vl or kalaazar. Treatmentbased strategy for the management of postkala. Postkalaazar dermal leishmaniasis associated with aids. People with pkdl, whose number is gradually on the rise in india, are considered to be a silent parasite pool for transmission of vl.
Quantifying the infectiousness of postkalaazar dermal. Charles abongomera uganda 48 th international course in health development september 19, 2011 september 7, 2012. Nonleishmania parasite in fatal visceral leishmaniasis. Postkalaazar dermal leishmaniasis article about post. Involvement of the mucosae is very rare and unusual in pkdl. Postkalaazar dermal leishmaniasis definition of post.
Currently, treatment is mainly with sodium stibogluconate ssg, an expensive and fairly toxic drug and. Postkalaazar dermal leishmaniasis patients included in the xenodiagnosis experiments. With kalaazar incidence close to the elimination target, there is an increased urgency to better define pkdl infectivity and quantify its role in maintaining transmission. Post kala azar dermal leishmaniasis pkdl is a sequel of vl. It is characterized by non ulcerating skin lesion, which is of 3 types. In bangladesh, there are 26 treatment centers that manage leishmaniasis cases coming from 100 endemic upazilas subdistricts of 26 districts these include vl, pkdl, treatment. It occurs typically 12 years after recovery from vl. Standing at a turning point in vl medicine, we had the opportunity to organize the expert conference entitled consultative meeting on elimination of. Post kalaazar dermal leishmaniasis pkdl is a chronic dermal manifestation which appears in a small proportion of cases following cure from visceral leishmaniasis vl episode, and occasionally in patients with no history of vl.
Postkalaazar dermal leishmaniasis in the indian subcontinent. Containing post kalaazar dermal leishmaniasis pkdl. Post kalaazar dermal leishmaniasis pkdl, a cutaneous sequela of visceral. Half of cases worldwide occur in india, with up to 90% of these in bihar state. Post kalaazar dermal leishmaniasis pkdl is a difficult to treat skin condition that develops in up to 10% of vl cases following treatment in the indian subcontinent.
The clinical features include a skin rash consisting of macules, papules or nodules in an otherwise healthy individual. Infectivity of postkalaazar dermal leishmaniasis patients to sand flies. A threat to the southeast asia region kalaazar elimination programme. Post kalaazar dermal leishmaniasis pkdl is a neglected complication of visceral leishmaniasis vl. In the present study, biopsy specimens from hypopigmented macules, nodules or plaques of 25 patients clinically diagnosed as pkdl were evaluated for epidermal and dermal. Post kala azar dermal leishmaniasis pkdl post kala azar dermal leishmaniasis is a condition in which leishmania donovani parasites invades in skin cells. Inferring transmission trees to guide targeting of interventions against visceral leishmaniasis and postkalaazar dermal leishmaniasis lloyd a. Despite many options, treatment of vl in india is far from satisfactory due to high incidence.
Post kalaazar dermal leishmaniasis pkdl, usually presents in patients with a history of treated visceral leishmaniasis vl caused by l. Postkalaazar dermal leishmaniasis pkdl is a dermatologic manifestation that usually occurs after visceral leishmaniasis vl caused by leishmania donovani. Postkalaazar dermal leishmaniasis follows an attack of visceral leishmaniasis and is caused by the same organism, i. Postkalaazar dermal leishmaniasis pkdl is thought to play a role. The incidence of pkdl varies across countries and no uptodate global estimate is available. This complication of vl is characterized by a macular, maculopapular, and nodular rash in a patient who has recovered from vl and who is otherwise well 400. Postkalaazar dermal leishmaniasis pkdl is a dermatosis that affects more than 50% of successfully treated visceral leishmaniasis vl patients in sudan. Leishmaniasis cutaneous and visceral kalaazar, black fever, dumdum fever, oriental sore, tropical sore, uta, visceral chiclero ulcer, aleppo boi, pian bois. Postkalaazar dermal leishmaniasis pkdl follows visceral. Pdf on mar 28, 2019, nirmalya chakrabarti and others published histopathological study of post kalaazar dermal leishmaniasis and its. Overview of leishmaniasis with special emphasis on kala.
Pdf leishmaniasis is a diverse group of human illness caused by the protozoan parasite of. Because his illness did not respond to therapy, the patient underwent splenectomy. Diagnosis of vl in dogs in latin america and mediterranean countries remains confusing because of rampant asymptomatic infections and elevated antibodies against leishmania spp 5. Relationship between treatment regimens for visceral. During the next several years, the clinical approach to vl and to post kala azar dermal leishmaniasis in the indian subcontinent and southasia will need to change. The immunology of postkalaazar dermal leishmaniasis pkdl. There was no other systemic complaints like fever, pain abdomen or. Visceral leishmaniasis, postkalaazar dermal leishmaniasis, aids. Pdf histopathological study of post kalaazar dermal. Postkalaazar dermal leishmaniasis pkdl dermatosis occurs in. It is characterized by hypopigmented patches, a macular or maculopapular rash and nodular skin lesions on the body surface. A positive reaction an area of induration after 72 hours is produced in cured kala azar cases 6 to 8 weeks after recovery and represent a delayed hypersensitivity reaction accompanied by cellmediated immunity. Background post kalaazar dermal leishmaniasis pkdl develops in patients apparently cured of visceral leishmaniasis vl, and is the strongest contender for being the disease reservoir. Post kalaazar dermal leishmaniasis following treatment.
Open access protocol study on the safety and ef cacy of. Patient was diagnosed as kalaazar about 3 years previously, and was treated suboptimally. Inferring transmission trees to guide targeting of. August 2017 importance leishmaniasis is an important complex of protozoal vectorborne diseases that affects both humans and animals. Post kala azar dermal leishmaniasis pkdl, a sequel to vl in india and africa, is often confused with other skin diseases 3,4. In addition, probable relapses were diagnosed in 3 previously treated kalaazar patients.
In the state of assam, india, kalaazar epidemics occurred during 18751950 and resulted in thousands of deaths in the districts of kamrup, garo hills, goalpara, and nagaon 1,2. Postkalaazar dermal leishmaniasis pkdl, a sequel to vl in india and africa, is often confused with other skin diseases 3,4. Insights into the possible role of ifng and ifngr1 in kala. We searched medline for eligible studies investigating the diagnostic accuracy of any test for pkdl. Pkdl is considered an important reservoir for the parasite and its treatment may help in the control of vl. Currently there is no strategy for prevention of pkdl and vlr. In east africa it is reported to occur among up to 50% of all vl patients, on the indian subcontinent isc it is less common. Kalaazar visceral leishmaniasis is a fatal disease caused by a protozoan parasite leishmania donovani and transmitted by the female sandfly, phlebotomus argentipes. Adverse effects of antileishmanial drugs can affect patients quality of life and adherence to therapy for visceral leishmaniasis vl and postkalaazar dermal leishmaniasis pkdl. Author summary postkalaazar dermal leishmaniasis pkdl, a sequale of visceral leishmaniasis vl, and reappearance vl visceral leishmaniasis relapse, vlr are intraepidemic reservoirs of vl and threats control of vl in long run. Challenges in the diagnosis of post kalaazar dermal leishmaniasis. Visceral leishmaniasis vl, also known as kalaazar, is caused by the parasite l.
Post kalaazar dermal leishmaniasis dhillon et al case. Post kala azar dermal leishmaniasis pkdl is a recurrence of kala azar that may appear on the skin of affected individuals months and up to 20 years after being partially treated, untreated or even in those considered adequately treated. Post kala azar dermal leishmaniasis pkdl is an unusual dermatosis caused by a parasite leishmania donovani ld. Postkalaazar dermal leishmaniasis pkdl is a late clinical outcome of visceral leishmaniasis vl. Altogether, we were able to reliably assign status with respect to kalaazar for 2,356 97% of 2,439 persons, of whom 2 9% had kalaazar or a history of kalaazar. The rash usually starts around the mouth from where it spreads to other parts of the body depending on severity. Kala azar is a slow progressing indigenous disease caused by a protozoan parasite of the genus leishmania.
Visceral leishmaniasis vl or kala azar is the most serious form of human leishmaniasis, responsible for over 20,000 deaths annually, and post kala azar dermal leishmaniasis pkdl is a stigmatizing skin condition that often occurs in patients after successful treatment for vl. The parasite primarily infects the reticuloendothelial system and may be found in abundance in bone marrow, spleen and liver. A serum based kit for the diagnosis of visceral leishmaniasis kala azar and pkdl by dr. In sudan, they can be demonstrated in up to 60% of treated cases. Postkalaazar dermal leishmaniasis pkdl is a complication of visceral leishmaniasis vl. E, direct xenodiagnosis placing hand in cage with sand flies. Pkdl is thought to be a reservoir for transmission of vl, thus, adequate control of pkdl plays a key role in the ongoing effort to eliminate vl. Post kala azar dermal leishmaniasis and leprosy prevalence. Among the manifestations of leishmaniasis, post kalaazar dermal leishmaniasis pkdl. Dermal lesions known as post kala azar dermal leishmaniasis pkdl have rarely been reported in brazil, and the clinical aspect of the disseminated papular skin lesions on this patient differed from the clinical presentation of pkdl. Kalaazar and postkalaazar dermal leishmaniasis, assam. Macular variety a 7yearold boy presented with numerous asymptomatic whitish flat lesions of varying sizes over the whole body for last two years. Easy test for visceral leishmaniasis and postkalaazar.