Clinico-epidemiological analysis of Post kala-azar dermal leishmaniasis (PKDL) cases in India over last two decades: a hospital based retrospective study.

V Ramesh,Poonam Salotra,Ashwani Kumar Mishra,Ruchi Singh,Himanshu Kaushal

doi:10.1186/s12889-015-2424-8

Abstract

BackgroundPatients with Post kala-azar dermal leishmaniasis (PKDL) are considered a reservoir of Leishmania donovani. It is imperative to identify and treat them early for control of visceral leishmaniasis (VL), a current priority in the Indian subcontinent. We explored trends in clinico-epidemiological features of PKDL cases over last two decades, for improving management of the disease.MethodsClinically suspected cases were diagnosed with rK39 strip test followed by parasitological confirmation by microscopy and/or PCR/qPCR in skin tissue/slit aspirates. Patients were treated with antimonials till 2008 and subsequently with miltefosine.ResultsThe study indicated higher incidence of PKDL cases in areas of high endemicity for VL, with 20 % cases reporting no history of VL. Approximately 26 % cases of PKDL were initially misdiagnosed at primary health centers. Duration between onset of PKDL and diagnosis was above 12 months in 80 % cases. Diagnostic sensitivity was 32-36 % with microscopy and 96–100 % with PCR/qPCR. Compliance to treatment was over 85 % with miltefosine while 15 % with antimonials. Relapse rate with miltefosine was up to 13.2 %.ConclusionsPKDL patients tend to delay reporting and are often misdiagnosed. Confirmatory diagnosis using minimally invasive skin slit aspirate samples would help overcome such issues. There was a paradigm shift in compliance with miltefosine; however, increasing relapse rate indicated the need for newer therapies with oral formulations.

Highlights

Patients with Post kala-azar dermal leishmaniasis (PKDL) are considered a reservoir of Leishmania donovani
Post kala-azar dermal leishmaniasis (PKDL), a dermal sequel of visceral leishmaniasis (VL), is reported in areas endemic for Leishmania donovani in the Indian subcontinent, Sudan and its adjoining areas [3, 4], sporadic cases have been reported from China, Japan, Iran and Iraq [5, 6]
PKDL predominant in areas of high endemicity for VL A total of 282 PKDL cases (Male, n = 225, Female, n = 57) were registered over last two decades since the year 1995 (Fig. 1)

Summary

Introduction

Patients with Post kala-azar dermal leishmaniasis (PKDL) are considered a reservoir of Leishmania donovani. It is imperative to identify and treat them early for control of visceral leishmaniasis (VL), a current priority in the Indian subcontinent. The disease manifests in different clinical forms, ranging from cutaneous leishmaniasis (CL) to disfiguring mucosal lesions to the most severe form, visceral leishmaniasis (VL). Post kala-azar dermal leishmaniasis (PKDL), a dermal sequel of VL, is reported in areas endemic for Leishmania donovani in the Indian subcontinent, Sudan and its adjoining areas [3, 4], sporadic cases have been reported from China, Japan, Iran and Iraq [5, 6]. The disease is characterized by different clinical presentations from simple hypo-pigmented macular form to more developed lesions comprising of papular, nodular cutaneous lesions and/or polymorphic forms with mixed lesions.

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Discussion

Conclusion