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Kala Azar in South Asia pp 7–21Cite as

Containing Post Kala-Azar Dermal Leishmaniasis (PKDL): Pre-requisite for Sustainable Elimination of Visceral Leishmaniasis (VL) from South Asia

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Abstract

Post Kala-Azar Dermal Leishmaniasis (PKDL) is a chronic dermal manifestation which appears in a small proportion of cases following cure from visceral leishmaniasis (VL) episode, and occasionally in patients with no history of VL. The global prevalence of PKDL is not well studied and the available data are based only on estimates. As per the available reports, the incidence of PKDL varies considerably within endemic countries. PKDL diagnosis remains a challenge more because serology does not have much relevance while parasitological and molecular diagnostic tests show either low sensitivity or are difficult to decentralize in the field. The available treatment options are costly, lengthy and frequently toxic. It is believed that PKDL has a multi-factorial and complex origin combining host and parasite factors and perhaps the treatment rendered in VL treatment. PKDL patients harbor Leishmania parasites in the skin, therefore, are considered a durable reservoir of infection that may propagate VL transmission, especially during inter-epidemic periods. Hence, PKDL poses a serious threat to the success of VL elimination program in South Asia and calls for combined and coordinated efforts towards its surveillance and management in India , Nepal , and Bangladesh . In a nutshell, containing PKDL is a must for sustainable elimination of VL from South Asia where VL transmission is anthroponotic .

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References

  1. World Health Organization. Post-kala-azar dermal leishmaniasis: a manual for case management and control. Rep. a WHO consulative Meet. 2012:2–3.

    Google Scholar 

  2. Croft SL, Sundar S, Fairlamb AH. Drug resistance in leishmaniasis. Clin Microbiol Rev. 2006;19(1):111–26. doi:10.1128/CMR.19.1.111-126.2006.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kumar D, Ramesh V, Verma S, Ramam M, Salotra P. Post-kala-azar dermal leishmaniasis (PKDL) developing after treatment of visceral leishmaniasis with amphotericin B and miltefosine. Ann Trop Med Parasitol. 2009;103(8):727–30. doi:10.1179/000349809X12554106963438.

    Article  CAS  PubMed  Google Scholar 

  4. Pandey K, Das VNR, Singh D, et al. Post-kala-azar dermal leishmaniasis in a patient treated with injectable paromomycin for visceral leishmaniasis in India. J Clin Microbiol. 2012;50(4):1478–9. doi:10.1128/JCM.05966-11.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Desjeux P, Ghosh RS, Dhalaria P, Strub-Wourgaft N, Zijlstra EE. Report of the post kala-azar dermal leishmaniasis (PKDL) consortium meeting, New Delhi, India, 27–29 June 2012. Parasit Vectors. 2013;6(1):196. doi:10.1186/1756-3305-6-196.

    Google Scholar 

  6. Rahman KM, Islam S, Rahman MW, et al. Increasing incidence of post-kala-azar dermal leishmaniasis in a population-based study in Bangladesh. Clin Infect Dis. 2010;50(1):73–6. doi:10.1086/648727.

    Article  PubMed  Google Scholar 

  7. Mondal D, Nasrin KN, Huda MM, et al. Enhanced case detection and improved diagnosis of PKDL in a kala-azar-endemic area of Bangladesh. PLoS Negl Trop Dis. 2010;4(10):e832. doi:10.1371/journal.pntd.0000832.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Islam S, Kenah E, Bhuiyan MAA, et al. Clinical and immunological aspects of post-kala-azar dermal leishmaniasis in Bangladesh. Am J Trop Med Hyg. 2013;89(2):345–53. doi:10.4269/ajtmh.12-0711.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ramesh V, Mukherjee A. Post-kala-azar dermal leishmaniasis. Int J Dermatol. 1995;34(2):85–91.

    Article  CAS  PubMed  Google Scholar 

  10. Singh RP, Picado A, Alam S, et al. Post-kala-azar dermal leishmaniasis in visceral leishmaniasis-endemic communities in Bihar, India. Trop Med Int Heal. 2012;17(11):1345–8. doi:10.1111/j.1365-3156.2012.03067.x.

    Article  Google Scholar 

  11. Uranw S, Ostyn B, Rijal A, et al. Post-kala-azar dermal leishmaniasis in nepal: a retrospective cohort study (2000–2010). PLoS Negl Trop Dis. 2011;5(12):e1433. doi:10.1371/journal.pntd.0001433.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Singh RP. Observation on dermal leishmanoid in Bihar. Indian J Dermatol. 1968;13(3):59–63.

    CAS  PubMed  Google Scholar 

  13. Ramesh V, Singh N. A clinical and histopathological study of macular type of post-kala-azar dermal leishmaniasis. Trop Doct. 1999;29(4):205–7.

    Article  CAS  PubMed  Google Scholar 

  14. Ramesh V, Ramam M, Singh R, Salotra P. Hypopigmented post-kala-azar dermal leishmaniasis. Int J Dermatol. 2008;47(4):414–6. doi:10.1111/j.1365-4632.2008.03621.x.

    Article  CAS  PubMed  Google Scholar 

  15. Saha S, Mazumdar T, Anam K, et al. Leishmania promastigote membrane antigen-based enzyme-linked immunosorbent assay and immunoblotting for differential diagnosis of Indian post-kala-azar dermal leishmaniasis. J Clin Microbiol. 2005;43(3):1269–77. doi:10.1128/JCM.43.3.1269-1277.2005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Musa AM, Khalil EAG, Raheem MA, et al. The natural history of Sudanese post-kala-azar dermal leishmaniasis: clinical, immunological and prognostic features. Ann Trop Med Parasitol. 2002;96(8):765–72. doi:10.1179/000349802125002211.

    Article  CAS  PubMed  Google Scholar 

  17. Zijlstra EE, Musa AM, Khalil EAG. el-Hassan IM, el-Hassan AM. Post-kala-azar dermal leishmaniasis. Lancet Infect Dis. 2003;3(2):87–98.

    Article  CAS  PubMed  Google Scholar 

  18. Ismail A, Khalil EAG, Musa AM, et al. The pathogenesis of post kala-azar dermal leishmaniasis from the field to the molecule: does ultraviolet light (UVB) radiation play a role? Med Hypotheses. 2006;66(5):993–9. doi:10.1016/j.mehy.2005.03.035.

    Article  CAS  PubMed  Google Scholar 

  19. El Hassan AM, Khalil EA, el Sheikh EA, Zijlstra EE, Osman A, Ibrahim ME. Post kala-azar ocular leishmaniasis. Trans R Soc Trop Med Hyg. 1998;92(2):177–9.

    Article  PubMed  Google Scholar 

  20. Rihl M, Stoll M, Ulbricht K, Bange F-C, Schmidt R-E. Successful treatment of post-kala-azar dermal leishmaniasis (PKDL) in a HIV infected patient with multiple relapsing leishmaniasis from Western Europe. J Infect. 2006;53(1):e25–7. doi:10.1016/j.jinf.2005.09.015.

    Article  PubMed  Google Scholar 

  21. Stark D, Pett S, Marriott D, Harkness J. Post-kala-azar dermal leishmaniasis due to leishmania infantum in a human immunodeficiency virus type 1-infected patient. J Clin Microbiol. 2006;44(3):1178–80. doi:10.1128/JCM.44.3.1178-1180.2006.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Antinori S, Longhi E, Bestetti G, et al. Post-kala-azar dermal leishmaniasis as an immune reconstitution inflammatory syndrome in a patient with acquired immune deficiency syndrome. Br J Dermatol. 2007;157(5):1032–6. doi:10.1111/j.1365-2133.2007.08157.x.

    Article  CAS  PubMed  Google Scholar 

  23. Singh A, Ramesh V, Ramam M. Histopathological characteristics of post kala-azar dermal leishmaniasis: a series of 88 patients. Indian J Dermatol Venereol Leprol. 2015;81(1):29–34. doi:10.4103/0378-6323.148562.

    Article  PubMed  Google Scholar 

  24. Salotra P, Singh R. Challenges in the diagnosis of post kala-azar dermal leishmaniasis. Indian J Med Res. 2006;123(3):295–310.

    PubMed  Google Scholar 

  25. Salotra P, Sreenivas G, Nasim AA, Subba Raju BV, Ramesh V. Evaluation of enzyme-linked immunosorbent assay for diagnosis of post-kala-azar dermal leishmaniasis with crude or recombinant k39 antigen. Clin Diagn Lab Immunol. 2002;9(2):370–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Riera C, Fisa R, Lopez P, et al. Evaluation of a latex agglutination test (KAtex) for detection of Leishmania antigen in urine of patients with HIV-Leishmania coinfection: value in diagnosis and post-treatment follow-up. Eur J Clin Microbiol Infect Dis. 2004;23(12):899–904. doi:10.1007/s10096-004-1249-7.

    CAS  PubMed  Google Scholar 

  27. Singh R, Subba Raju BV, Jain RK, Salotra P. Potential of direct agglutination test based on promastigote and amastigote antigens for serodiagnosis of post-kala-azar dermal leishmaniasis. Clin Diagn Lab Immunol. 2005;12(10):1191–4. doi:10.1128/CDLI.12.10.1191-1194.2005.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Salotra P, Sreenivas G, Pogue GP, et al. Development of a species-specific PCR assay for detection of leishmania donovani in clinical samples from patients with kala-azar and post-kala-azar dermal leishmaniasis. J Clin Microbiol. 2001;39(3):849–54. doi:10.1128/JCM.39.3.849-854.2001.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Verma S, Bhandari V, Avishek K, Ramesh V, Salotra P. Reliable diagnosis of post-kala-azar dermal leishmaniasis (PKDL) using slit aspirate specimen to avoid invasive sampling procedures. Trop Med Int Health. 2013;18(3):268–75. doi:10.1111/tmi.12047.

    PubMed  Google Scholar 

  30. Verma S, Avishek K, Sharma V, Negi NS, Ramesh V, Salotra P. Application of loop-mediated isothermal amplification assay for the sensitive and rapid diagnosis of visceral leishmaniasis and post-kala-azar dermal leishmaniasis. Diagn Microbiol Infect Dis. 2013;75(4):390–5. doi:10.1016/j.diagmicrobio.2013.01.011.

    Article  CAS  PubMed  Google Scholar 

  31. Roustan G, Jiménez JA, Gutiérrez-Solar B, Gallego JL, Alvar J, Patrón M. Post-kala-azar dermal leishmaniasis with mucosal involvement in a kidney transplant recipient: treatment with liposomal amphotericin B. Br J Dermatol. 1998;138(3):526–8.

    Article  CAS  PubMed  Google Scholar 

  32. El Hassan AM, Ghalib HW, Zijlstra EE, et al. Post kala-azar dermal leishmaniasis in the Sudan: clinical features, pathology and treatment. Trans R Soc Trop Med Hyg. 1992;86(3):245–8.

    Article  PubMed  Google Scholar 

  33. Ismail A, Kharazmi A, Permin H, el Hassan AM. Detection and characterization of leishmania in tissues of patients with post kala-azar dermal leishmaniasis using a specific monoclonal antibody. Trans R Soc Trop Med Hyg. 1997;91(3):283–5.

    Article  CAS  PubMed  Google Scholar 

  34. Musa AM, Khalil EAG, Mahgoub FAE, et al. Immunochemotherapy of persistent post-kala-azar dermal leishmaniasis: a novel approach to treatment. Trans R Soc Trop Med Hyg. 2008;102(1):58–63. doi:10.1016/j.trstmh.2007.08.006.

    Article  CAS  PubMed  Google Scholar 

  35. Dey A, Singh S. Genetic heterogeneity among visceral and post-kala-azar dermal leishmaniasis strains from eastern India. Infect Genet Evol. 2007;7(2):219–22. doi:10.1016/j.meegid.2006.09.001.

    Article  CAS  PubMed  Google Scholar 

  36. Subba Raju BV, Singh R, Sreenivas G, Singh S, Salotra P. Genetic fingerprinting and identification of differentially expressed genes in isolates of Leishmania donovani from Indian patients of post-kala-azar dermal leishmaniasis. Parasitology. 2008;135(Pt 1):23–32. doi:10.1017/S0031182007003484.

    CAS  PubMed  Google Scholar 

  37. Subba Raju BV, Gurumurthy S, Kuhls K, Bhandari V, Schnonian G, Salotra P. Genetic typing reveals monomorphism between antimony sensitive and resistant leishmania donovani isolates from visceral leishmaniasis or post kala-azar dermal leishmaniasis cases in India. Parasitol Res. 2012;111(4):1559–68. doi:10.1007/s00436-012-2996-5.

    Article  CAS  PubMed  Google Scholar 

  38. Das VNR, Ranjan A, Pandey K, et al. Short report: clinical epidemiologic profile of a cohort of post-kala-azar dermal leishmaniasis patients in Bihar, India. Am J Trop Med Hyg. 2012;86(6):959–61. doi:10.4269/ajtmh.2012.11-0467.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Croft SL. PKDL—a drug related phenomenon? Indian J Med Res. 2008;128(1):10–1.

    PubMed  Google Scholar 

  40. Thakur CP, Kumar A, Mitra G, et al. Impact of amphotericin-B in the treatment of kala-azar on the incidence of PKDL in Bihar, India. Indian J Med Res. 2008;128(1):38–44.

    CAS  PubMed  Google Scholar 

  41. Das VNR, Pandey K, Verma N, et al. Short report: development of post-kala-azar dermal leishmaniasis (PKDL) in miltefosine-treated visceral leishmaniasis. Am J Trop Med Hyg. 2009;80(3):336–8.

    PubMed  Google Scholar 

  42. Elshafie AI, Ahlin E, Mathsson L, ElGhazali G, Rönnelid J. Circulating immune complexes (IC) and IC-induced levels of GM-CSF are increased in sudanese patients with acute visceral Leishmania donovani infection undergoing sodium stibogluconate treatment: implications for disease pathogenesis. J Immunol. 2007;178(8):5383–9.

    Article  CAS  PubMed  Google Scholar 

  43. Saha S, Mondal S, Ravindran R, et al. IL-10- and TGF-beta-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. J Immunol. 2007;179(8):5592–603.

    Article  CAS  PubMed  Google Scholar 

  44. Rathi SK, Pandhi RK, Chopra P, Khanna N. Lesional T-cell subset in post-kala-azar dermal leishmaniasis. Int J Dermatol. 2005;44(1):12–3. doi:10.1111/j.1365-4632.2004.01579.x.

    Article  PubMed  Google Scholar 

  45. Ganguly S, Das NK, Panja M, et al. Increased levels of interleukin-10 and IgG3 are hallmarks of Indian post-kala-azar dermal leishmaniasis. J Infect Dis. 2008;197(12):1762–71. doi:10.1086/588387.

    Article  CAS  PubMed  Google Scholar 

  46. Ganguly S, Mukhopadhyay D, Das NK, et al. Enhanced lesional Foxp3 expression and peripheral anergic lymphocytes indicate a role for regulatory T cells in Indian post-kala-azar dermal leishmaniasis. J Invest Dermatol. 2010;130(4):1013–22. doi:10.1038/jid.2009.393.

    Article  CAS  PubMed  Google Scholar 

  47. Katara GK, Ansari NA, Verma S, Ramesh V, Salotra P. Foxp3 and IL-10 expression correlates with parasite burden in lesional tissues of post kala azar dermal leishmaniasis (PKDL) patients. PLoS Negl Trop Dis. 2011;5(5):e1171. doi:10.1371/journal.pntd.0001171.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Ansari NA, Ramesh V, Salotra P. Interferon (IFN)-gamma, tumor necrosis factor-alpha, interleukin-6, and IFN-gamma receptor 1 are the major immunological determinants associated with post-kala azar dermal leishmaniasis. J Infect Dis. 2006;194(7):958–65. doi:10.1086/506624.

    Article  CAS  PubMed  Google Scholar 

  49. Ansari NA, Katara GK, Ramesh V, Salotra P. Evidence for involvement of TNFR1 and TIMPs in pathogenesis of post-kala-azar dermal leishmaniasis. Clin Exp Immunol. 2008;154(3):391–8. doi:10.1111/j.1365-2249.2008.03761.x.

    Google Scholar 

  50. Salih MA, Ibrahim ME, Blackwell JM, et al. IFNG and IFNGR1 gene polymorphisms and susceptibility to post-kala-azar dermal leishmaniasis in Sudan. Genes Immunol. 2007;8(1):75–8. doi:10.1038/sj.gene.6364353.

    Article  CAS  Google Scholar 

  51. Katara GK, Ansari NA, Singh A, Ramesh V, Salotra P. Evidence for involvement of Th17 type responses in post kala azar dermal leishmaniasis (PKDL). PLoS Negl Trop Dis. 2012;6(6):e1703. doi:10.1371/journal.pntd.0001703.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. World Health Organization. Control of the leishmaniases. World Health Organ. Tech Rep Ser. 2010;(949):xii–xiii, 1–186, back cover.

    Google Scholar 

  53. Addy M, Nandy A. Ten years of kala-azar in west Bengal, Part I. Did post-kala-azar dermal leishmaniasis initiate the outbreak in 24-Parganas? Bull. World Health Organ. 1992;70(3):341–6.

    Google Scholar 

  54. Dye C, Wolpert DM. Earthquakes, influenza and cycles of Indian kala-azar. Trans R Soc Trop Med Hyg. 1988;82(6):843–50.

    Article  CAS  PubMed  Google Scholar 

  55. Das VNR, Siddiqui NA., Verma RB, et al. Asymptomatic infection of visceral leishmaniasis in hyperendemic areas of Vaishali district, Bihar, India: A challenge to kala-azar elimination programmes. Trans R Soc Trop Med Hyg. 2011;105(11):661–666. doi:10.1016/j.trstmh.2011.08.005.

    Google Scholar 

  56. Ostyn B, Gidwani K, Khanal B, et al. Incidence of symptomatic and asymptomatic leishmania donovani infections in high-endemic foci in India and Nepal: a prospective study. PLoS Negl Trop Dis. 2011;5(10). doi:10.1371/journal.pntd.0001284.

    Google Scholar 

  57. Stauch A, Sarkar RR, Picado A, et al. Visceral leishmaniasis in the indian subcontinent: modelling epidemiology and control. PLoS Negl Trop Dis. 2011;5(11). doi:10.1371/journal.pntd.0001405.

    Google Scholar 

  58. Sharma MC, Gupta AK, Das VNR, et al. Leishmania donovani in blood smears of asymptomatic persons. Acta Trop. 2000;76(2):195–6. doi:10.1016/S0001-706X(00)00068-1.

    Article  CAS  PubMed  Google Scholar 

  59. Topno RK, Das VNR, Ranjan A, et al. Asymptomatic infection with visceral leishmaniasis in a disease-endemic area in Bihar, India. Am J Trop Med Hyg. 2010;83:502–6. doi:10.4269/ajtmh.2010.09-0345.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Sudarshan M, Singh T, Singh AK, et al. Quantitative PCR in epidemiology for early detection of visceral leishmaniasis cases in India. PLoS Negl Trop Dis. 2014;8(12):e3366. doi:10.1371/journal.pntd.0003366.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Munro DD, Du Vivier A, Jopling WH. Post kala-azar dermal leishmaniasis. Br J Dermatol. 1972;87(4):374–8.

    Article  CAS  PubMed  Google Scholar 

  62. Ono H, Ghoreishi M, Yokozeki H, Katayama I, Nishioka K. A case of post-kala-azar dermal leishmaniasis. J Dermatol. 1998;25(2):118–20.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. National Institute of Pathology (ICMR), New Delhi, India

    Poonam Salotra & Himanshu Kaushal

  2. Department of Dermatology & STD, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India

    V. Ramesh

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  1. Poonam Salotra
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  2. Himanshu Kaushal
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Correspondence to Poonam Salotra .

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  1. The University of Tokyo Hospital, Bunkyō, Tokyo, Japan

    E. Noiri

  2. Kalazar Research Center, Muzaffarpur, India

    T.K. Jha

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Salotra, P., Kaushal, H., Ramesh, V. (2016). Containing Post Kala-Azar Dermal Leishmaniasis (PKDL): Pre-requisite for Sustainable Elimination of Visceral Leishmaniasis (VL) from South Asia. In: Noiri, E., Jha, T. (eds) Kala Azar in South Asia. Springer, Cham. https://doi.org/10.1007/978-3-319-47101-3_2

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