Active surveillance identified a neglected burden of macular cases of Post Kala-azar Dermal Leishmaniasis in West Bengal.

Ritika Sengupta,Mitali Chatterjee,Nilay Kanti Das,Manab Kumar Ghosh,Surya Jyati Chaudhuri,Srija Moulik,Bibhuti Saha,Guilherme L Werneck

doi:10.1371/journal.pntd.0007249

Abstract

BackgroundPost Kala-azar Dermal Leishmaniasis (PKDL) develops in patients apparently cured of Visceral Leishmaniasis (VL), and is the strongest contender for being the disease reservoir. Therefore, existence of a few cases is sufficient to trigger an epidemic of VL in a given community, emphasizing the need for its active detection and in turn ensuring success of the current elimination program. This study explored the impact of active surveillance on the demographic profile of PKDL patients in West Bengal.Methodology/Principal findingsPatients with PKDL were recruited through passive (2003-date, n = 100) and active surveillance (2015-date, n = 202), the former from outpatient departments of dermatology in medical colleges in West Bengal and the latter through an active door-to-door survey in four VL hyper-endemic districts of West Bengal. Passive surveillance indicated a male preponderance and a predominance of polymorphic lesions, whereas active surveillance indicated absence of any gender bias and more importantly, macular PKDL constituted almost 50% of the population burden. In terms of polymorphic vs. macular PKDL, the former appeared at a later age, their disease duration was longer and had a higher parasite burden. In the polymorphic variant, the lesional distribution was asymmetrical, comprised of papules/nodules/macules that were present mainly in sun-exposed areas whereas in macular cases, the hypopigmented patches were diffusely present all over the body.Conclusions/SignificanceActive surveillance unraveled a disease component whose demographic profile showed important differences with PKDL cases who sought treatment in government hospitals. Detection of a higher proportion of macular cases indicates that this variant is not an uncommon presentation as conventionally stated in text books, and should be studied in greater detail to ensure success of the ongoing Leishmaniasis elimination programme.

Highlights

Leishmaniasis are a group of neglected tropical diseases caused by the parasite Leishmania and demonstrates clinical pleomorphism with regard to the causative species, disease reservoirs, vectors as host-immune responses
This study explored the impact of active surveillance on the demographic profile of Post Kala-azar Dermal Leishmaniasis (PKDL) patients in West Bengal
Post Kala-azar Dermal Leishmaniasis (PKDL) is a dermal condition that occurs in South Asia in 10–20% of patients after apparent cure from Visceral Leishmaniasis (VL)

Summary

Introduction

Leishmaniasis are a group of neglected tropical diseases caused by the parasite Leishmania and demonstrates clinical pleomorphism with regard to the causative species, disease reservoirs, vectors as host-immune responses. It can manifest as life-threatening and/or disfiguring lesions ranging from innocuous self-healing cutaneous lesions to fatal visceralization or a dermal dissemination [1]. Post Kala-azar Dermal Leishmaniasis (PKDL) develops in patients apparently cured of Visceral Leishmaniasis (VL), and is the strongest contender for being the disease reservoir.

Objectives

Methods

Results

Discussion

Conclusion