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Risk factors for post-kala-azar dermal leishmaniasis (PKDL): Challenges in understanding pathophysiology
1Rotterdam Center for Tropical Medicine, Rotterdam, Netherlands.
Plos Neglected Tropical Diseases
|February 23, 2026
Summary
Post-kala-azar dermal leishmaniasis (PKDL) risk factors differ between Eastern Africa and Southeast Asia. Understanding these factors, including host, parasite, and environmental influences, is crucial for developing effective control strategies for this neglected tropical disease.
Area of Science:
- Neglected tropical diseases
- Leishmaniasis research
- Dermatology and immunology
Background:
- Post-kala-azar dermal leishmaniasis (PKDL) presents differently in Eastern Africa (EA) and Southeast Asia (SEAR).
- EA PKDL occurs in young children shortly after visceral leishmaniasis (VL) treatment, while SEAR PKDL affects adolescents/young adults years after VL treatment.
- Risk factors for PKDL development remain poorly understood in both regions.
Purpose of the Study:
- To review and synthesize current knowledge on risk factors, epidemiology, genetics, pathophysiology, immune responses, and co-infections in PKDL.
- To identify key differences and similarities in PKDL presentation and risk factors between EA and SEAR.
- To inform future research and control strategies for PKDL.
Main Methods:
- A comprehensive literature search was conducted to gather data on PKDL.
- Extracted information focused on host factors, parasite factors, drug pharmacokinetics/pharmacodynamics, environmental influences, and co-infections.
- Data synthesis aimed to identify patterns and significant risk factors associated with PKDL.
Main Results:
- Host factors: Young age and male gender are risk factors in EA; decreased IFNGR1 expression is observed in PKDL in both EA and SEAR.
- Parasite factors: Differences in VL/PKDL strains and co-infections (e.g., Leptomonas seymouri) are implicated.
- Other factors: Previous VL treatment, drug properties, arsenic exposure, UV light, and microbial co-infections influencing immune response downgrading are significant.
Conclusions:
- Further research into PKDL pathophysiology is essential to understand immune response modulation.
- Optimizing VL treatment, potentially using multidrug regimens or immune modifiers, could lower PKDL incidence.
- An integrated approach to PKDL management, considering co-infections and skin disease strategies, is recommended for effective control.
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