Active surveillance identified a neglected burden of macular cases of Post Kala-azar Dermal Leishmaniasis in West Bengal

Abstract

BackgroundPost Kala-azar Dermal Leishmaniasis (PKDL) develops in patients apparently cured of Visceral Leishmaniasis (VL), and is the strongest contender for being the disease reservoir. Therefore, existence of a few cases is sufficient to trigger an epidemic of VL in a given community, emphasizing the need for its active detection and in turn ensuring success of the current elimination program. This study explored the impact of active surveillance on the demographic profile of PKDL patients in West Bengal.Methodology/Principal findingsPatients with PKDL were recruited through passive (2003-date, n = 100) and active surveillance (2015-date, n = 202), the former from outpatient departments of dermatology in medical colleges in West Bengal and the latter through an active door-to-door survey in four VL hyper-endemic districts of West Bengal. Passive surveillance indicated a male preponderance and a predominance of polymorphic lesions, whereas active surveillance indicated absence of any gender bias and more importantly, macular PKDL constituted almost 50% of the population burden. In terms of polymorphic vs. macular PKDL, the former appeared at a later age, their disease duration was longer and had a higher parasite burden. In the polymorphic variant, the lesional distribution was asymmetrical, comprised of papules/nodules/macules that were present mainly in sun-exposed areas whereas in macular cases, the hypopigmented patches were diffusely present all over the body.Conclusions/SignificanceActive surveillance unraveled a disease component whose demographic profile showed important differences with PKDL cases who sought treatment in government hospitals. Detection of a higher proportion of macular cases indicates that this variant is not an uncommon presentation as conventionally stated in text books, and should be studied in greater detail to ensure success of the ongoing Leishmaniasis elimination programme.

Conversion of asymptomatic infection to symptomatic visceral leishmaniasis: A study of possible immunological markers

“…From qPCR analysis, unlike sero-positives, we get evidence for the first time in this study that suspected individuals living in households with family history, were at particularly high risk of infection. The usefulness of quantitative PCR in epidemiology has recently been shown for the early detection of visceral leishmaniasis cases [11,12,57,58]. This analysis helped us to identify 42 asymptomatic VL subjects and it necessitated to explore, how many of them converted into disease as well as the factors that promoted conversion of asymptomatic individuals to VL cases.…”

“…This necessitates comprehensive longitudinal studies to identify the components which will dictate the conversion from asymptomatic to symptomatic VL. The diagnosis of VL has been further advanced by molecular tools such as PCR [10] and qPCR (<10% to up to 30%) [11,12]. More importantly, the most of asymptomatic individuals are identified from areas, where VL remains endemic and even exceed the number of symptomatic cases [13][14][15][16][17][18].…”

Iron trafficking in patients with Indian Post kala-azar dermal leishmaniasis

“…Patients clinically diagnosed with PKDL (n = 25) were recruited either from the Dermatology outpatient departments of School of Tropical Medicine/Calcutta Medical College/Institute of PG Medical Education & Research, Kolkata, West Bengal or from active field surveys conducted in endemic districts of West Bengal (Malda, Dakshin Dinajpur, Murshidabad and Birbhum) by a camp approach, wherein a door-to-door survey was conducted by Kala-azar Technical Supervisors using standard case definitions and defined risk factors e.g. living in an endemic area and having an epidemiological link (past history of VL) as also a rK39 strip test positivity [12].…”

“…Patients with PKDL (n = 25; Table 2) were randomly recruited by active or passive surveillance; the population included polymorphic (n = 10) and macular (n = 15) cases with a view to represent the present scenario of PKDL [12]. The rk39 test was positive in all cases while the presence of Leishman Donovan bodies was identified by Giemsa staining in all the polymorphic cases, but not in the macular variant.…”

Metalloprotease Gp63 targeting novel glycoside exhibits potential antileishmanial activity

“…We further evaluated the effect the Gly 2 on the clinical isolate of PKDL strain, BS12 of L. donovani [33]. The results showed pronounced toxic effect of the Gly 2 on the Indian origin leishmania isolate of PKDL.…”