Clinicopathological and Immunological Changes in Indian Post Kala-Azar Dermal Leishmaniasis (PKDL) Cases in relation to Treatment: A Retrospective Study.

Neena Verma,Sanjiv Bimal,Vidya Nand Rabi Das,Krishna Pandey,Chandra Shekhar Lal,Ashish Kumar Singh,Prabhat Kumar Sinha,Pradeep Das,Dharmendra Singh

doi:10.1155/2015/745062

Abstract

Post-kala-azar dermal leishmaniasis (PKDL) is an important factor in kala-azar transmission; hence its early detection and assessment of effective treatment is very important for disease control. In present study on 60 PKDL cases presented with macular, mixed papulonodular, or erythematous lesions, Leishmania parasites were demonstrated microscopically in 91% of papulonodular and 40% of macular lesions. Cellular infiltrates in skin biopsy imprint smears from lesions were mononuclear cells, 25–300/OIF (oil immersion field), predominantly histiocytes with vacuolation, many lymphocytes, some plasma cells, and Leishmania amastigotes 0–20/OIF. Cases with no demonstrable parasites were diagnosed on the basis of past history of VL, lesion's distribution, cytopathological changes, and positive DAT (86.83%). Following antileishmanial treatment with SAG, papulonodular forms of PKDL lesions disappeared clinically but microscopically the mononuclear cells (20–200/OIF) persisted in the dermal lesions. Response observed in macular PKDL lesions was poor which persisted both clinically and cytopathologically. Follow-up of PKDL will assess the effectivity of treatment as either disappearance of lesions or any relapse. Studies on involvement of immunological factors, that is, certain cytokines (IL-10, TGF-β, etc.) and chemokines (macrophage inflammatory protein, MIP 1-α, etc.) in PKDL, may provide insight for any role in the treatment response.

Highlights

Leishmania, a protozoan parasite, is the causative agent of various forms of leishmaniasis, like visceral form (VL), mucocutaneous form (MCL), and cutaneous form (CL), of which VL is fatal
Since Post-kala-azar dermal leishmaniasis (PKDL) cases harbour leishmania parasites superficially in the skin lesions, it is easy for the vector sandfly to pick up the parasites from the lesions and it is considered an important source for transmission of the disease
The present study was undertaken in PKDL cases from VL endemic areas of Bihar, India, with objective to detect the different forms of PKDL cases and to correlate the cytopathological changes and parasite load in their dermal lesions with immunological changes and clinical response after full course of treatment with sodium antimony gluconate (SAG)

Summary

Introduction

Leishmania, a protozoan parasite, is the causative agent of various forms of leishmaniasis, like visceral form (VL), mucocutaneous form (MCL), and cutaneous form (CL), of which VL is fatal. PKDL is common in India where it occurs in 6–20% of kala-azar (VL) cases following its attack [3]. It is characterized by hypopigmented macules (discrete or confluent) all over body sparing palm, soles, scalp, and axillae and erythematous papules or nodules predominantly over face. PKDL has long been suspected as a potential reservoir of kala-azar infection. It is considered an important factor in disease transmission between kala-azar outbreaks in India [4]. Since PKDL cases harbour leishmania parasites superficially in the skin lesions, it is easy for the vector sandfly to pick up the parasites from the lesions and it is considered an important source for transmission of the disease. The present study was undertaken in PKDL cases from VL endemic areas of Bihar, India, with objective to detect the different forms of PKDL cases and to correlate the cytopathological changes and parasite load in their dermal lesions with immunological changes and clinical response after full course of treatment with sodium antimony gluconate (SAG)

Methods

Results

Conclusion