Containing Post Kala-Azar Dermal Leishmaniasis (PKDL): Pre-requisite for Sustainable Elimination of Visceral Leishmaniasis (VL) from South Asia

Abstract

Post Kala-Azar Dermal Leishmaniasis (PKDL) is a chronic dermal manifestation which appears in a small proportion of cases following cure from visceral leishmaniasis (VL) episode, and occasionally in patients with no history of VL. The global prevalence of PKDL is not well studied and the available data are based only on estimates. As per the available reports, the incidence of PKDL varies considerably within endemic countries. PKDL diagnosis remains a challenge more because serology does not have much relevance while parasitological and molecular diagnostic tests show either low sensitivity or are difficult to decentralize in the field. The available treatment options are costly, lengthy and frequently toxic. It is believed that PKDL has a multi-factorial and complex origin combining host and parasite factors and perhaps the treatment rendered in VL treatment. PKDL patients harbor Leishmania parasites in the skin, therefore, are considered a durable reservoir of infection that may propagate VL transmission, especially during inter-epidemic periods. Hence, PKDL poses a serious threat to the success of VL elimination program in South Asia and calls for combined and coordinated efforts towards its surveillance and management in India, Nepal, and Bangladesh. In a nutshell, containing PKDL is a must for sustainable elimination of VL from South Asia where VL transmission is anthroponotic .