Increasing Incidence of Post–Kala‐Azar Dermal Leishmaniasis in a Population‐Based Study in Bangladesh (original) (raw)
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PLoS neglected tropical diseases, 2017
The South-East Asia Region Kala-azar Elimination Programme (KAEP) is expected to enter the consolidation phase in 2017, which focuses on case detection, vector control, and identifying potential sources of infection. Post-kala-azar dermal leishmaniasis (PKDL) is thought to play a role in the recurrence of visceral leishmaniasis (VL)/kala-azar outbreaks, and control of PKDL is among the priorities of the KAEP. We reviewed the literature with regard to PKDL in Asia and interpreted the findings in relation to current intervention methods in the KAEP in order to make recommendations. There is a considerable knowledge gap regarding the pathophysiology of VL and PKDL, especially the underlying immune responses. Risk factors (of which previous VL treatments may be most important) are poorly understood and need to be better defined. The role of PKDL patients in transmission is largely unknown, and there is insufficient information about the importance of duration, distribution and severity ...
Post kala-azar dermal leishmaniasis: A threat to elimination program
PLOS Neglected Tropical Diseases, 2020
Leishmaniasis remains a public health concern around the world that primarily affects poor folks of the developing world spanning across 98 countries with mortality of 0.2 million to 0.4 million annually. Post kala-azar dermal leishmaniasis (PKDL) is the late skin manifestation of visceral leishmaniasis (VL). It has been reported that about 2.5% to 20% of patients recovered from VL develop PKDL having stilted macular or nodular lesions with parasites. In the Indian subcontinent (ISC), it manifests a few months after recovery from VL, though in Africa it can occur simultaneously with VL or a little later. New cases of PKDL are also observed without prior VL in the ISC. These individuals with PKDL represent an important but largely neglected reservoir of infection that perpetuates anthroponotic Leishmania donovani transmission in the ISC and can jeopardize the VL elimination program as these cases can infect the sand flies and spread the endemic. Therefore, it becomes imperative to eradicate PKDL as a part of the VL elimination program. With the limited treatment options besides little knowledge on PKDL, this review stands out in focusing on different aspects that should be dealt for sustained VL elimination.
Parasites & Vectors, 2013
Post kala-azar dermal leishmaniasis (PKDL) is a neglected complication of visceral leishmaniasis (VL)―a deadly, infectious disease that claims approximately 20,000 to 40,000 lives every year. 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. Over the past few years, several expert meetings have recommended that a greater focus on PKDL was needed, especially in South Asia. This report summarizes the Post Kala-Azar Dermal Leishmaniasis Consortium Meeting held in New Delhi, India, 27–29 June 2012. The PKDL Consortium is committed to promote and facilitate activities that lead to better understanding of all aspects of PKDL that are needed for improved clinical management and to achieve control of PKDL and VL. Fifty clinicians, scientists, policy makers, and advocates came together to discuss issues relating to PKDL epidemiology, diagnosis, pathogenesis, clinical presentation, treatment, and co...
PLOS ONE
Para Kala-azar Dermal Leishmaniasis (Para-KDL) manifests the concomitant presence of Post Kala-azar Dermal Leishmaniasis and Visceral Leishmaniasis and works as a reservoir of infection. The study discusses the cases and their management and aims to address the gaps within existing methods of diagnosis and treatment. This retrospective cross-sectional study discusses 16 Para-KDL cases with one-year follow-up data, treated between 2012–2021 at the Surya Kanta Kala-azar Research Center, Bangladesh. We collected data from hospital records and used STATA 16 to analyze and see the frequency distribution and variable means. We found five patients without any history of kala-azar infection. All the patients were treated with 20 mg/kg Liposomal Amphotericin B in 4 divided doses except one with a history of AmBisome hypersensitivity. One year after treatment, all patients were free from skin lesions, with no hepatosplenomegaly, and observed significant improvement in BMI and hemoglobin level...
Overview of Leishmaniasis with Special Emphasis on Kala-azar in South Asia
Neglected tropical diseases, 2017
Abbreviations AVL Anthroponotic visceral leishmaniasis CL Cutaneous leishmaniasis DALY Disability-adjusted life year IRS Insecticide residue spread MCL Mucocutaneous leishmaniasis NTD Neglected tropical diseases PKDL Post-kala-azar dermal leishmaniasis PV Parasite-containing vacuole rK39 Recombinant kinesin 39 amino acid repeats rKE16 Recombinant kinesin antigen from L. donovani VL Visceral leishmaniasis ZCL Zoonotic cutaneous leishmaniasis 1 Global Overview of Leishmaniasis 1.1 Disease Types Leishmaniasis is a complex disease caused by Leishmania infection, producing variable clinical symptoms, e.g., cutaneous, mucocutaneous, and visceral leishmaniases [1-3]. Cutaneous leishmaniasis (CL) caused, for example, by Leishmania major/L. tropica is marked by the appearance of skin lesion in various forms, which are often innocuous and self-healing, while mucocutaneous leishmaniasis (MCL) caused, for example, by L. braziliensis is a protracted disease, resulting sometimes in facial disfigurement of the ear, mouth, and nose. Neither CL nor MCL is lifethreatening per se. Only in non-healing case has death of these patients been reported due to secondary infections or other causes, e.g., suicide as a result of unbearable psychological stress. Visceral leishmaniasis (VL) caused by L. donovani/L. infantum is far more severe. It is often fatal, if untreated, resulting from systemic and progressive infection of macrophages by Leishmania in the reticuloendothelial systems or lymphoid organs, chiefly the spleen, liver, and bone marrow. Disorders of hematological and hepatosplenic functions are thus the clinical manifestations of VL, including hepatosplenomegaly, fever, anemia, leucopenia, hypergammaglobulinemia, and cachexia. The development of all leishmaniases follows a chronic course lasting for months and sometimes years. A vibrant and active biomedical research community has long existed in India, under the aegis of both national and international organizations, for basic, clinical, and other researches of kala-azar. There are internationally sought-after kala-azar clinics in the well-established endemic sites, drug/vaccine production facilities, and many kala-azar research laboratories. Nowhere else in the world can one find another country, except perhaps Brazil, to match India in the scale of dedication, devotion, and contribution to kala-azar research. Given below are examples of some Indian institutions and recent kala-azar research to illustrate the points. 4.1 Indian Institutions with Kala-azar Research Components Some Indian government agencies, which provide administrative and financial support:
American Journal of Tropical Medicine and Hygiene, 2012
Post-kala-azar dermal leishmaniasis (PKDL) has important public health implications for transmission of visceral leishmaniasis (VL). Clinical and epidemiologic profiles of 102 PKDL patients showed that median age of males and females at the time of diagnosis was significantly different (P = 0.013). A significant association was observed between family history of VL and sex of PKDL patients (χ 2 = 5.72, P 0.01). Nearly 33% of the patients showed development of PKDL within one year of VL treatment. The observed time (median = 12 months) between appearance of lesions and diagnosis is an important factor in VL transmission. A significant association was observed between type of lesions and duration of appearance after VL treatment (χ 2 = 6.59, P = 0.001). Because PKDL was observed during treatment with all currently used anti-leishmanial drugs, new drug regimens having high cure rates and potential to lower the PKDL incidence need to be investigated.
Elimination of visceral leishmaniasis on the Indian subcontinent
The Lancet. Infectious diseases, 2016
Visceral leishmaniasis is a serious public health problem on the Indian subcontinent, causing high morbidity and mortality. The governments in the region launched a visceral leishmaniasis elimination initiative in 2005. We review knowledge gaps and research priorities. Key challenges include low coverage of health services for those most at risk, drug resistance, the absence of a vaccine, and the complex biology of the sandfly-human host transmission cycle. Vector control is an essential component, but innovation in this field is insufficient. Substantial progress has been made in the area of diagnostic, therapeutic, and vaccine development, but there are still many hurdles to overcome. For visceral leishmaniasis elimination to become a reality, effective deployment of these existing and new tools is essential. A strong commitment at community level is imperative, and appropriate diagnostic and treatment services as well as effective epidemiological surveillance need to be ensured.
Challenges for management of post kala-azar dermal leishmaniasis and future directions
Research and Reports in Tropical Medicine, 2014
Post kala-azar dermal leishmaniasis (PKDL) is a skin complication resulting from infection with Leishmania donovani (LD) parasite. It mostly affects individuals who have previously suffered from visceral leishmaniasis (VL) caused by LD. In some cases, PKDL develops among people infected with LD, but do not show any symptoms of VL. Clinical presentation includes hypopigmented macules/papules/nodules or polymorphic lesions (combination of two or more lesions). Except for skin lesions, PKDL patients are generally healthy and usually do not seek medical care. These patients play an important role in interepidemic transmission of the infection and subsequent VL outbreak. Therefore, proper diagnosis and treatment of PKDL patients is important for the control of VL in endemic countries, especially in the Indian subcontinent where VL is anthroponotic. Here, we report the challenges in the estimation of PKDL burden, its diagnosis, and treatment, and suggest possible solutions based on recent literature, reports, published manuals, and web-based information.