Abstract
Post kala-azar dermal leishmaniasis (PKDL) is a neglected complication of visceral leishmaniasis (VL)―a deadly, infectious disease that claims approximately 20,000 to 40,000 lives every year. PKDL is thought to be a reservoir for transmission of VL, thus, adequate control of PKDL plays a key role in the ongoing effort to eliminate VL. Over the past few years, several expert meetings have recommended that a greater focus on PKDL was needed, especially in South Asia. This report summarizes the Post Kala-Azar Dermal Leishmaniasis Consortium Meeting held in New Delhi, India, 27–29 June 2012. The PKDL Consortium is committed to promote and facilitate activities that lead to better understanding of all aspects of PKDL that are needed for improved clinical management and to achieve control of PKDL and VL. Fifty clinicians, scientists, policy makers, and advocates came together to discuss issues relating to PKDL epidemiology, diagnosis, pathogenesis, clinical presentation, treatment, and control. Colleagues who were unable to attend participated during drafting of the consortium meeting report.
Highlights
Post kala-azar dermal leishmaniasis (PKDL) is a neglected complication of visceral leishmaniasis (VL, known as kala-azar or black fever)―a deadly, infectious disease that claims approximately 20,000 to 40,000 lives every year [1]
PKDL cases occurred after all known VL treatments; out of 10,000 patients treated with AmBisomeW 20 mg/kg in India by Médecins Sans Frontières (MSF), 0.9% developed PKDL
There is a clear link between the number of VL and PKDL cases in active case finding around recent VL cases
Summary
Post kala-azar dermal leishmaniasis (PKDL) is a neglected complication of visceral leishmaniasis (VL, known as kala-azar or black fever)―a deadly, infectious disease that claims approximately 20,000 to 40,000 lives every year [1]. While PKDL cases were reported in a limited number of patients treated with miltefosine for VL, only a few cases were reported following VL treatment with amphotericin B. This was illustrated in the 1980s when SSG was massively used and there was an increase in the incidence of PKDL followed by a large VL epidemic. The prevalence of PKDL is low in Ethiopia compared with Sudan but is higher in HIV co-infected patients, where it is often seen in an atypical presentation. Surveillance conducted in Gondar with a wide catchment area indicated that from July to December 2011, 243 patients were screened for VL, 67 were treated for VL, 22 of these (32%) were HIV positive and there were 3 PKDL cases. This design should provide data on the rate that sandflies become infected as well as those that become infective
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