Post kala-azar dermal leishmaniasis: a neglected aspect of kala-azar control programmes

Thakur, C.P.; Kumar, KM Prasanna

doi:10.1080/00034983.1992.11812678

Cited by 99 publications

(61 citation statements)

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“…9 In Indian sub-continent, untreated patients with VL and PKDL are considered to be the only reservoirs that provide a source of exposure by disseminating the causative parasite to unaffected persons living in the same community. 9,10 Of these two reservoirs of L. donovani, untreated PKDL continues for years in the community and provides easy access for sand flies to acquire parasites. 8 It has been documented that Phlebotomus aregentipes, the vector that transmits VL in India, has the potential to develop infection by producing promastigotes in the mid gut and is thus capable of transmitting parasites to human by bites.…”

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Clinical Epidemiologic Profile of a Cohort of Post–Kala-Azar Dermal Leishmaniasis Patients in Bihar, India

Das¹,

Ranjan²,

Pandey³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Abstract. 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.Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis caused by Leishmania donovani parasites in the skin after apparently successful treatment of patients with visceral leishmaniasis (VL) or those without a history of VL. It is characterized by macular, maculopapular, and nodular lesions in patients recovering from VL who are otherwise healthy.1 It occurs in nearly 10-20% of patients cured of VL within 1-5 years in India, and in approximately 50% of patients in Sudan within six months. [1][2][3][4] In the Indian subcontinent, kala-azar appears to occur at an interval of 10-15 years.5 Patients with PKDL have immense public health importance because they act as reservoirs of infection. 6Because there is no animal reservoir of L. donovani, in this sub-continent, it is important to detect patients with PKDL and treat them properly to prevent future outbreaks of VL. 7It has been reported that a large proportion of VL patients treated with sodium antimony gluconate (SAG) have a high probability of development of PKDL.8 It is not known whether other anti-leishmanial drugs have a similar posttreatment effect in development of PKDL. Clinical and epidemiologic aspects of PKDL are important for understanding transmission dynamics and defining VL control strategies. Because there is no mechanism currently available to detect PKDL cases at the community level, control strategies currently operational in disease-endemic areas would fail to achieve their goal of elimination. Therefore, we studied a cohort of PKDL cases diagnosed during 2007-2010 to identify clinical and epidemiologic features that are important to public health.The study was conducted at the Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India during June 2007-December 2010. A total of 102 confirmed patients with PKDL were enrolled in the study after providing informed consent. A semi-structured questionnaire was administered to each person to obtain demographic characteristics, area of residence, history of VL, relapse of VL, family history of VL or...

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Clinical Epidemiologic Profile of a Cohort of Post–Kala-Azar Dermal Leishmaniasis Patients in Bihar, India

Das¹,

Ranjan²,

Pandey³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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“…Clinically, the condition is characterized by the appearance of macules, papules, or nodules in the skin (6). Affected persons, though clinically well, harbor the Leishmania parasite in their skin lesions, and thus become an important reservoir in anthroponotic transmission of leishmaniasis (7). Although PKDL has been commonly diagnosed by microscopy, the sensitivity of this technique is low due to the very low number of parasites in slit skin smears and skin biopsy specimens.…”

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PCR-Based Detection of Leishmania DNA in Skin Samples of Post Kala-Azar Dermal Leishmaniasis Patients from an Endemic Area of Bangladesh

et al. 2012

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SUMMARY: Post kala-azar dermal leishmaniasis (PKDL) is a sequel of visceral leishmaniasis (VL) and PKDL patients are an important reservoir for anthroponotic transmission of VL. Therefore, diagnosis and treatment of PKDL is important for the kala-azar elimination program in South Asia, including Bangladesh. While definitive diagnosis of PKDL is still based on microscopy, despite the low sensitivity of this method of diagnosis, PCR for identification of kinetoplast DNA (kDNA) from Leishmania parasites is expected to be a rapid and sensitive diagnostic method. We attempted PCR-based diagnosis from skin biopsy specimens and compared PCR to other available detection methods in order to determine the acceptability and feasibility of the PCR diagnostic method in an endemic area of VL in Bangladesh. Both skin biopsy specimens and blood samples were collected from 110 patients suspected to have PKDL from 6 subdistrict health complexes in Mymensingh, Bangladesh. Using microscopy, we identified 32 samples (29.1z) that were positive for Leishmania. Immunochromatography tests indicated that 85 samples (77.3z) were positive for Leishmania. In contrast, a total of 104 (94.5z) samples tested positive using nested PCR, while unaffected portions of skin from PKDL patients tested negative. Sequencing analysis of the PCR products indicated that the amplified portion had more than 98z nucleotide sequence identity to the Leishmania donovani reference strain, D10. These findings indicate that the PCR method using a skin biopsy is highly sensitive and useful for confirmatory diagnosis of PKDL.

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“…KA transmission in India is thought to be anthroponotic, and in the absence of animal reservoirs, PKDL patients are deemed to be the singular source of the parasites. Therefore, the identification and treatment of PKDL cases are recognized as prerequisites for the successful elimination of KA (10).…”

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Nested PCR Assay for Detection of Leishmania donovani in Slit Aspirates from Post-Kala-Azar Dermal Leishmaniasis Lesions

Gannavaram¹,

Ansari²,

Kataria

et al. 2004

J Clin Microbiol

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Post kala-azar dermal leishmaniasis: a neglected aspect of kala-azar control programmes

Cited by 99 publications

References 3 publications

Clinical Epidemiologic Profile of a Cohort of Post–Kala-Azar Dermal Leishmaniasis Patients in Bihar, India

Clinical Epidemiologic Profile of a Cohort of Post–Kala-Azar Dermal Leishmaniasis Patients in Bihar, India

PCR-Based Detection of Leishmania DNA in Skin Samples of Post Kala-Azar Dermal Leishmaniasis Patients from an Endemic Area of Bangladesh

Nested PCR Assay for Detection of Leishmania donovani in Slit Aspirates from Post-Kala-Azar Dermal Leishmaniasis Lesions

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