Post-kala-azar dermal leishmaniasis in the Sudan: clinical presentation and differential diagnosis

Abstract

Post-kala-azar dermal leishmaniasis (PKDL) is a common complication following kala-azar (visceral leishmaniasis). In a prospective study in a village in the endemic area for kala-azar in the Sudan, 105 of 183 (57%) kala-azar patients developed PKDL. There was a significantly higher PKDL rate (69%) in those who received inadequate and irregular treatment of kala-azar than in those who were treated with stibogluconate 20 mg kg-1 daily for 15 days (35%). The group of patients who developed PKDL did not differ from those who did not develop PKDL with regard to age and sex distribution, reduction in spleen size, and conversion in the leishmanin skin test (LST). In a clinical study, 416 PKDL patients were analysed and divided according to grade of severity. Severe PKDL was more frequent in younger age groups (P < 0.001); there was an inverse correlation between grade and conversion in the LST (P < 0.01). In 16% of patients tested, parasites were demonstrated in inguinal lymph node or bone marrow aspirates, indicating still visceral disease (para-kala-azar dermal leishmaniasis); there was no correlation between the presence of parasites and grade of severity. Conversion rates in the LST were lower than in those who did not have demonstrable parasites (11% and 37%, respectively; P < 0.01). In the absence of reliable and practical diagnostic tests, PKDL may be diagnosed on clinical grounds and differentiated from other conditions, of which miliaria rubra was the most common. Differentiation from leprosy was most difficult.

Atypical Lesions as a Sign of Cutaneous Dissemination of Visceral Leishmaniasis in a Human Immunodeficiency Virus–Positive Patient Simultaneously Infected by Two Viscerotropic Leishmania Species

“…22 However, some cases of African kalaazar have cutaneous lesions and parasites in lymph nodes and bone marrow, a clinical presentation known as para-kala-azar dermal leishmaniasis. 23 In our patient, the distribution of cutaneous lesions and their visual aspect were compatible with that of classical PKDL. The patient also showed features of African para-kala-azar dermal leishmaniasis, i.e., concomitance of cutaneous and visceral active disease and parasites present in the liver, bone marrow and skin.…”

IL-10- and TGF-β-Mediated Susceptibility in Kala-azar and Post-kala-azar Dermal Leishmaniasis: The Significance of Amphotericin B in the Control of Leishmania donovani Infection in India

“…Disease manifestation in PKDL patients involves different types of dermal lesions indicating different levels of disease aggravation (14,55,56). In India, PKDL appears either with hypopigmented macules that may coalesce and spread over the body or in the form of erythematous eruptions that lead to the formation of papules, nodules, and plaques or combinations thereof with progression of the disease (12,14).…”

Post Kala Azar Dermal Leishmaniasis (PKDL) Presenting with Ulcerated Chronic Paronychia Like Lesion

“…In grade three crusting, ulceration, sloughing, scaling, and spreading to the mucosa of the lip (cheilitis) and the palate may occur. 6 However, atypical and unusual presentations are not uncommon. Bari et al have noted unusual presentations in 5.7% cases among 718 patients with cutaneous leishmaniasis.…”

“…In a recent cross-sectional descriptive study of 105 patients with PKDL in eastern Sudan, a papular or nodular rash was most frequently seen (51%); other types of rash were maculopapular (23%), micropapular (measles-like) (17%) and macular (9%). 6 From India, three main presentations have been described, of which one or two may predominate: erythema and induration on the butterfly area of the face that shows photosensitivity; multiple symmetrical hypopigmented macules that may coalesce; and combinations of papules, nodules, and plaques. 7,8 Although there are differences in description of clinical findings from Sudan and other areas; however, in most reports, macular, papular, and nodular lesions are considered the hallmarks of PKDL.…”