Recent advances in post-kala-azar dermal leishmaniasis

Mondal, Dinesh; Khan, Gulam Musawwir

doi:10.1097/qco.0b013e32834a8ba1

Cited by 39 publications

(40 citation statements)

References 30 publications

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“…PKDL or dermal leishmanoid11 is a condition in which dermal lesions can be heavily parasitized in a subset of patients successfully treated for VL, and it occurs mainly in India and Sudan in patients infected by L. donovani 13,14. They remain asymptomatic for months to years and then develop a progressive proliferation of parasites within the skin, giving rise to diffuse macular, maculopapular, or nodular lesions 13.…”

Section: Pathogenesismentioning

confidence: 99%

“…The patient has an irregular fever, anemia, and leukopenia; hepatosplenomegaly and bone marrow suppression are characteristic (see above); and HIV coinfections often produce atypical presentations 11–13. Rates of PKDL vary regionally, arising within 6 months in up to 50% of treated VL patients in parts of Sudan, but within 2–3 years in only approximately 5%–10% of patients in India 12–14…”

Section: Diagnosismentioning

confidence: 99%

“…Bone marrow aspiration (from the sternum) is frequently used,11 but it is a specialized technique with lower sensitivity 12. Detection of parasites in nodular forms of PKDL is easier than in macular forms 13,14. Inoculation of biopsy materials into culture media or laboratory rodents can be sensitive but slow 1…”

Section: Diagnosismentioning

confidence: 99%

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Epidemiology of visceral leishmaniasis

Ready¹

2014

CLEP

405

306

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Leishmania species are the causative agents of leishmaniasis, a neglected tropical disease. These parasitic protozoans are usually transmitted between vertebrate hosts by the bite of blood sucking female phlebotomine sand flies. This review focuses on the two parasites causing most human visceral leishmaniasis (VL), which leads to substantial health problems or death for up to 400,000 people per year. Except for travel cases, Leishmania donovani infections are restricted to the (sub-)tropics of Asia and Africa, where transmission is mostly anthroponotic, while Leishmania infantum occurs in the drier parts of Latin America as well as in the Mediterranean climate regions of the Old World, with the domestic dog serving as the main reservoir host. The prevalence of VL caused by L. infantum has been declining where living standards have improved. In contrast, infections of L. donovani continue to cause VL epidemics in rural areas on the Indian subcontinent and in East Africa. The current review compares and contrasts these continental differences and suggests priorities for basic and applied research that might improve VL control. Transmission cycles, pathogenesis, diagnosis, treatment and prognosis, prevention (including vector control), surveillance, transmission modeling, and international control efforts are all reviewed. Most case detection is passive, and so routine surveillance does not usually permit accurate assessments of any changes in the incidence of VL. Also, it is not usually possible to estimate the human inoculation rate of parasites by the sand fly vectors because of the limitations of survey methods. Consequently, transmission modeling rarely passes beyond the proof of principle stage, and yet it is required to help develop risk factor analysis for control programs. Anthroponotic VL should be susceptible to elimination by rapid case detection and treatment combined with local vector control, and one of the most important interventions may well be socioeconomic development.

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Section: Pathogenesismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Epidemiology of visceral leishmaniasis

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2014

CLEP

405

306

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“…Although PKDL in Sudan can appear concurrently with, or sometimes in the absence of, VL, in general the disease is highly uncommon in patients who have not yet presented with VL and received treatment. Thus, certain therapies are actually considered a significant risk factor for developing the disease [10]. Because the therapies often restore or boost the patient’s inflammatory T helper 1 (Th1) immune response, PKDL is widely accepted as being an immunologically mediated disease (Box 2).…”

Section: Post-kala-azar Dermal Leishmaniasismentioning

confidence: 99%

The immunological, environmental, and phylogenetic perpetrators of metastatic leishmaniasis

Hartley

Drexler

Ronet

et al. 2014

Trends in Parasitology

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Cutaneous leishmaniases have persisted for centuries as chronically disfiguring parasitic infections affecting millions of people across the subtropics. Symptoms range from the more prevalent single, self-healing cutaneous lesion to a persistent, metastatic disease, where ulcerations and granulomatous nodules can affect multiple secondary sites of the skin and delicate facial mucosa, even sometimes diffusing throughout the cutaneous system as a papular rash. The basis for such diverse pathologies is multifactorial, ranging from parasite phylogeny to host immunocompetence and various environmental factors. Although complex, these pathologies often prey on weaknesses in the innate immune system and its pattern recognition receptors. This review explores the observed and potential associations among the multifactorial perpetrators of infectious metastasis and components of the innate immune system.

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“…Persistence of a mixed cellular immune response characterized by high levels of IL-10 and IFNγ after complete treatment of VL is associated with development of PKDL. 52 Therefore, immunoprophylaxis during the treatment of VL so as to enhance Th 1 cellular immune responses along with a well-tuned immunoregulatory response to infection may prevent the development of PKDL after treatment of VL. This is supported by the findings of the study in Sudan in which PKDL treatment was substantially improved by adding alum/alum + BCG vaccine to the conventional treatment with SSG.…”

Section: Prevention Of Pkdlmentioning

confidence: 99%

Challenges for management of post kala-azar dermal leishmaniasis and future directions

Mondal¹,

Hamano²,

Hasnain³

et al. 2014

RRTM

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Post kala-azar dermal leishmaniasis (PKDL) is a skin complication resulting from infection with Leishmania donovani (LD) parasite. It mostly affects individuals who have previously suffered from visceral leishmaniasis (VL) caused by LD. In some cases, PKDL develops among people infected with LD, but do not show any symptoms of VL. Clinical presentation includes hypopigmented macules/papules/nodules or polymorphic lesions (combination of two or more lesions). Except for skin lesions, PKDL patients are generally healthy and usually do not seek medical care. These patients play an important role in interepidemic transmission of the infection and subsequent VL outbreak. Therefore, proper diagnosis and treatment of PKDL patients is important for the control of VL in endemic countries, especially in the Indian subcontinent where VL is anthroponotic. Here, we report the challenges in the estimation of PKDL burden, its diagnosis, and treatment, and suggest possible solutions based on recent literature, reports, published manuals, and web-based information.

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Recent advances in post-kala-azar dermal leishmaniasis

Cited by 39 publications

References 30 publications

Epidemiology of visceral leishmaniasis

Epidemiology of visceral leishmaniasis

The immunological, environmental, and phylogenetic perpetrators of metastatic leishmaniasis

Challenges for management of post kala-azar dermal leishmaniasis and future directions

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