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Post-kala-azar dermal leishmaniasis.

E E Zijlstra1, A M Musa, E A G Khalil

  • 1EEZ is at the Department of Medicine, College of Medicine, Malawi

The Lancet. Infectious Diseases
|February 1, 2003
PubMed
Summary
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Post-kala-azar dermal leishmaniasis (PKDL) is a skin complication following visceral leishmaniasis (VL). Understanding PKDL pathogenesis and improving diagnostic and treatment strategies are crucial for controlling this parasitic disease reservoir.

Area of Science:

  • * Infectious Diseases
  • * Dermatology
  • * Immunology

Background:

  • * Post-kala-azar dermal leishmaniasis (PKDL) is a sequela of visceral leishmaniasis (VL), presenting as a distinct skin rash.
  • * PKDL is primarily observed in Sudan and India, following treated VL caused by *Leishmania donovani*.
  • * The condition likely serves as a parasite reservoir during interepidemic periods of VL.

Purpose of the Study:

  • * To review the pathogenesis, diagnosis, and treatment of PKDL.
  • * To highlight the immunological basis of PKDL development.
  • * To identify unresolved issues in PKDL control.

Main Methods:

  • * Review of existing literature on PKDL.
  • * Analysis of immunological markers, including cytokine profiles (IL-10, IFN-γ).

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  • * Evaluation of diagnostic techniques (microscopy, PCR, serology) and treatment modalities.

    • Main Results:

    • * PKDL pathogenesis is largely immunologically mediated, with elevated IL-10 predicting development and IFN-γ production linked to lesion appearance.
    • * Diagnosis is primarily clinical, though PCR and monoclonal antibodies offer higher sensitivity (>80%) than microscopy.
    • * Treatment varies by region; Indian PKDL requires treatment, while Sudanese cases often self-cure, with sodium stibogluconate and liposomal amphotericin B as key therapies.

    Conclusions:

    • * PKDL is an important immunological complication of VL with implications for disease transmission.
    • * While diagnostic and therapeutic advances have been made, further research is needed for effective control strategies.
    • * Newer agents like miltefosine show promise for PKDL management.