This study established that quantifying parasite load is an effective approach for monitoring patients with PKDL, wherein miltefosine demonstrated near-total parasite clearance and resolution of symptoms. However, in cases treated with LAmB, the persistence of parasites suggested treatment inadequacy. This needs immediate redressal in view of the leishmaniasis elimination program targeted for 2020.

BackgroundPost Kala Azar Dermal Leishmaniasis (PKDL) occurs as dermal consequence of previous Visceral Leishmaniasis (VL) infection and serves as an important reservoir for transmission of VL. Diagnosis of PKDL is often challenging for its symptomatic resemblance to other co-endemic diseases like Leprosy or Vitiligo. Parasitological examination by slit-skin smear and culture are the standard methods but lack high sensitivity. Thus, for efficient control of VL, reliable diagnostic and prognostic assay of PKDL are required.ObjectivePreviously, glycoproteins (9-OAcSA) have been reported as promising biomarkers of Indian VL patients. However, till date, the status of glycans in Indian PKDL patients remains unexplored. Accordingly, in this study, the glyco-profile of PKDL Circulating Immune Complexes (CICs) as compared to other cross diseases like Vitiligo and Leprosyhas been investigated. Further, a novel Glyco CIC assay has been developed for efficient Indian PKDL patient diagnosis.Methods/principal findingIn the present study, 90 PKDL patients were enrolled from 3 VL endemic districts of West Bengal during 2015–16. Glycosylation profile of isolated CICs from sera of PKDL patients were initially analyzed through gradient SDS gel electrophoresis followed by PAS silver double staining, which revealed the presence of several glycan rich PKDL specific proteins of varying molecular weights. To further characterize the glyco-profile of acid dissociated affinity purified immuno-reactive antigens present in the CICs, glycosylation was demonstrated in these purified CIC antigens by DIG glycan differentiation kit with or without glycosidase as well as neuraminidase treatment. Diagnostic evaluation of the newly developed colorimetric Glyco CIC assay through Receiver Operating Characteristic (ROC) curve analysis revealed excellent (0.99) AUC value as compared to other conventional serodiagnostic assays like PEG CIC, Parasite ELISA (IgG and IgM). Additionally, longitudinal monitoring of 18 PKDL patients further revealed its good prognostic utility.ConclusionThese results highlight the glycosylation status of CICs among Indian PKDL patients present in all the studied endemic districts of West Bengal. These PKDL biomarkers were completely absent in cross diseases like Vitiligo and Leprosy. Further, the newly developed Glyco CIC assay had an improved sensitivity of 95.6%, specificity of 99.3%, NPV of 97.1% and PPV of 98.9%.

Dengue fever is an arthropod-borne viral haemorrhagic fever. Suspected dengue patients admitted in the of School of Tropical Medicine, Kolkata were taken as a case after considering inclusion and exclusion criteria. Aim of this study was to determine the effect of doxycycline in course and final outcome of dengue fever. Selected patients were subjected to history, examination, necessary investigations and then were managed according to NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP) guidelines. A total of 24 serology proven dengue patients were included and followed up. Two groups (twelve in each) were allocated by simple random sampling. Treatment group was given doxycycline and control group were given placebo. Age and sex profile were similar in both groups. 75% of patients in treatment group had no bleeding with no patients having major bleed; where in control group 25% of had major bleeding. Plasma leakage were less in treatment group (25%) as compared to control group (58.3%). Hemodynamic compromise was more in control group (16.7%) as compared to treatment group (8.30%). 41.70% of patients in treatment group had no thrombocytopenia in comparison to control group (16.70%). Also, only 8.30% of patients had platelets below 10,000/cmm in treatment group where it is 16.70% in control group. Platelet transfusion was necessary in 8.30% of treatment group patient in comparison to 16.70% of control group patients. Liver involvement in control group was more in comparison to treatment group. Control group has pancreatic involvement in 16.60% of patients; renal involvement in 8.30% of patients; cardiac involvement in 8.30% of patients. Whereas no pancreatic, renal or cardiac involvement were seen in treatment group. An initial report of this study showed significant reduction in complications of dengue fever in respect to different organ involvement when treated with doxycycline.

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