Abstract
BackgroundVisceral leishmaniasis (VL), with the squeal of Post-kala-azar dermal leishmaniasis (PKDL), is a global threat for health. Studies have shown sodium stibogluconate (SSG) resistance in VL patients with chronic arsenic exposure. Here, we assessed the association between arsenic exposure and risk of developing PKDL in treated VL patients.MethodsIn this retrospective study, PKDL patients (n = 139), earlier treated with SSG or any other drug during VL, were selected from the study cohort. Trained physicians, unaware of arsenic exposure, interviewed them and collected relevant data in a questionnaire format. All probable water sources were identified around the patient’s house and water was collected for evaluation of arsenic concentration. A GIS-based village-level digital database of PKDL cases and arsenic concentration in groundwater was developed and individual point location of PKDL cases were overlaid on an integrated GIS map. We used multivariate logistic regression analysis to assess odds ratios (ORs) for association between arsenic exposure and PKDL development.ResultsOut of the 429 water samples tested, 403 had arsenic content of over 10 μg/L, with highest level of 432 μg/L among the seven study villages. Multivariate adjusted ORs for risk of PKDL development in comparison of arsenic concentrations of 10.1–200 μg/L and 200.1–432.0 μg/L were 1.85 (1.13–3.03) and 2.31 (1.39–3.8) respectively. Interestingly, similar results were found for daily dose of arsenic and total arsenic concentration in urine sample of the individual. The multivariate-adjusted OR for comparison of high baseline arsenic exposure to low baseline arsenic exposure of the individuals in the study cohort was 1.66 (95% CI 1.02–2.7; p = 0.04).ConclusionOur findings indicate the need to consider environmental factors, like long time arsenic exposure, as an additional influence on treated VL patients towards risk of PKDL development in Bihar.
Highlights
Visceral Leishmaniasis (VL) is one of the neglected tropical diseases and a major global threat for health worldwide [1,2]
Our findings indicate the need to consider environmental factors, like long time arsenic exposure, as an additional influence on treated Visceral leishmaniasis (VL) patients towards risk of Post-kala-azar dermal leishmaniasis (PKDL) development in Bihar
After plotting individual geocoded cohort addresses of PKDL cases on the arsenic distribution map using spatial join functionality, we found that 7 villages in Raghopur block of Vaishali district in Bihar indicate that arsenic concentrations are high in groundwater collected from the youngest alluvial terraces (Fig 4)
Summary
Visceral Leishmaniasis (VL) is one of the neglected tropical diseases and a major global threat for health worldwide [1,2]. It poses a major health problem in the poverty-ridden state of Bihar, which accounts for nearly 90% of the total cases in India [3]. Post-kala-azar dermal leishmaniasis (PKDL), a dermal sequel of VL, is caused by L. donovani, and is confined to South Asia (India, Nepal, and Bangladesh) and East Africa, mainly Sudan [4,5]. Visceral leishmaniasis (VL), with the squeal of Post-kala-azar dermal leishmaniasis (PKDL), is a global threat for health. We assessed the association between arsenic exposure and risk of developing PKDL in treated VL patients
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