Increasing Incidence of Post–Kala‐Azar Dermal Leishmaniasis in a Population‐Based Study in Bangladesh

Abstract

Post-kala-azar dermal leishmaniasis (PKDL) occurs after kala-azar treatment and acts as a durable infection reservoir. On the basis of active case finding among 22,699 respondents, 813 (3.6%) had had kala-azar since 2002, of whom 79 (9.7%) developed PKDL. Eight additional patients with PKDL had no history of kala-azar. Annual kala-azar incidence peaked at 85 cases per 10,000 person-years in 2004 and fell to 46 cases per 10,000 person-years in 2007, but PKDL incidence rose from 1 case per 10,000 person-years in 2002-2004 to 21 cases per 10,000 person-years in 2007. The rising PKDL incidence threatens the regional visceral leishmaniasis elimination initiative and underscores the urgent need for more effective PKDL diagnosis and treatment.

Clinical and Immunological Aspects of Post–Kala-Azar Dermal Leishmaniasis in Bangladesh

“…1,4 Recent articles suggest that the epidemiology varies widely, even within the Indian subcontinent. 6,16,17 Our data showed estimated cumulative PKDL incidence of 3% within 1 year, 10% within 2 years, and 17% within 5 years of kala-azar. By contrast, in a retrospective cohort in Nepal, the incidence was 1.4% within 2 years, 2.5% within 4 years, and 3.6% within 8 years.…”

“…We observed this pattern from 2000 to 2010 in Mymensingh District. 6,36 A similar but less marked kala-azar incidence peak was seen in 2007 in facility-based data from Bihar, India, although apparently without the PKDL echo. 37 Napier and Krisnan 22 attributed the pattern to progressively increasing population-level immunity.…”

“…1,5 In 2007, we initiated a study in a group of villages in Bangladesh. 6 The design included identification of kala-azar and PKDL cases through an initial retrospective survey followed by prospective surveillance to assess incidence and duration of the two conditions and identify risk factors for development of PKDL after kala-azar. A preliminary analysis showed a rising incidence of PKDL from 2002 to 2008.…”

“…A preliminary analysis showed a rising incidence of PKDL from 2002 to 2008. 6 Systematic examination of PKDL patients was performed to describe the spectrum of the disease in the community. Finally, serum specimens were collected from a subset of kala-azar and PKDL patients with the aim of describing cytokine profiles.…”

Prevalence of visceral leishmaniasis, risk factors and associated disorders: Knowledge of inhabitants and professionals in Fulbaria, Mymensingh

“…PKDL is a skin disorder which usually develops in 10-20% and about 60% of patients with visceral leishmaniasis (VL) after treatment respectively in the Indian subcontinent and Sudan. These patients are difficult to diagnose and treat, as some of them may not have even past history of VL (Rahman et al 2010). …”