Abstract
BackgroundThe South-East Asia Region Kala-azar Elimination Programme (KAEP) is expected to enter the consolidation phase in 2017, which focuses on case detection, vector control, and identifying potential sources of infection. Post-kala-azar dermal leishmaniasis (PKDL) is thought to play a role in the recurrence of visceral leishmaniasis (VL)/kala-azar outbreaks, and control of PKDL is among the priorities of the KAEP.Methodology and principal findingWe reviewed the literature with regard to PKDL in Asia and interpreted the findings in relation to current intervention methods in the KAEP in order to make recommendations. There is a considerable knowledge gap regarding the pathophysiology of VL and PKDL, especially the underlying immune responses. Risk factors (of which previous VL treatments may be most important) are poorly understood and need to be better defined. The role of PKDL patients in transmission is largely unknown, and there is insufficient information about the importance of duration, distribution and severity of the rash, time of onset, and self-healing. Current intervention methods focus on active case detection and treatment of all PKDL cases with miltefosine while there is increasing drug resistance. The prevention of PKDL by improved VL treatment currently receives insufficient attention.Conclusion and significancePKDL is a heterogeneous and dynamic condition, and patients differ with regard to time of onset after VL, chronicity, and distribution and appearance of the rash, as well as immune responses (including tendency to self-heal), all of which may vary over time. It is essential to fully describe the pathophysiology in order to make informed decisions on the most cost-effective approach. Emphasis should be on early detection of those who contribute to transmission and those who are in need of treatment, for whom short-course, effective, and safe drug regimens should be available. The prevention of PKDL should be emphasised by innovative and improved treatment for VL, which may include immunomodulation.
Highlights
Kala-azar/visceral leishmaniasis (VL) is endemic in the Indian subcontinent (ISC), affecting the Gangetic plains of India, Bangladesh, and Nepal.ln 2005, the governments of Bangladesh, India, and Nepal agreed on a regional initiative, the Regional Kala-azar Elimination Programme (KAEP), to eliminate VL as a public health problem from the region by 2015, which has been extended to 2017 [1]
Post-kala-azar dermal leishmaniasis (PKDL) is thought to play a role in the recurrence of visceral leishmaniasis (VL)/kala-azar outbreaks, and control of PKDL is among the priorities of the KAEP
We reviewed the literature with regard to PKDL in Asia and interpreted the findings in relation to current intervention methods in the KAEP in order to make recommendations
Summary
Kala-azar/visceral leishmaniasis (VL) is endemic in the Indian subcontinent (ISC), affecting the Gangetic plains of India, Bangladesh, and Nepal.ln 2005, the governments of Bangladesh, India, and Nepal agreed on a regional initiative, the Regional Kala-azar Elimination Programme (KAEP), to eliminate VL as a public health problem from the region by 2015, which has been extended to 2017 [1]. The key strategies for elimination were early diagnosis and complete case management; integrated vector management and vector surveillance; effective disease surveillance through passive and active case detection; social mobilisation and building partnerships; and implementation and operational research [3]. This multidisciplinary approach strategy aimed at reaching the elimination target of less than 1 kala-azar case in 10,000 population by 2015.
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