Post-kala-azar dermal leishmaniasis

Post-kala-azar dermal leishmaniasis (PKDL) is a skin condition that occurs in a subset of patients after they have recovered from visceral leishmaniasis, also known as kala-azar. It is caused by the same parasite, Leishmania donovani, and is characterized by skin lesions that can range from macules to nodules.

Epidemiology

PKDL is most commonly found in India, Sudan, and Bangladesh, where visceral leishmaniasis is endemic. The incidence of PKDL in these regions varies, with rates as high as 50% in Sudan and 5-10% in India. The condition typically develops 6 months to several years after the initial infection.

File:Leishmania donovani.jpg

Leishmania donovani, the parasite that causes PKDL

Pathogenesis

The exact mechanism of PKDL is not fully understood, but it is believed to be a result of an immune response to residual parasites in the skin. The parasites are taken up by macrophages, where they multiply and eventually cause the cells to burst, releasing more parasites into the surrounding tissue.

Clinical Features

PKDL presents as a range of skin lesions, from hypopigmented macules to erythematous papules, plaques, or nodules. The lesions are typically non-pruritic and can appear anywhere on the body, but are most commonly found on the face, upper chest, and arms.

Diagnosis

Diagnosis of PKDL is based on clinical features, history of visceral leishmaniasis, and laboratory tests. The gold standard for diagnosis is a skin biopsy, which will show the presence of Leishmania parasites.

Treatment

Treatment for PKDL is similar to that for visceral leishmaniasis and includes antimonial drugs, amphotericin B, and miltefosine. However, treatment can be challenging due to the long duration required and potential side effects.

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Amphotericin B, a common treatment for PKDL

Prevention and Control

Prevention of PKDL involves controlling the spread of visceral leishmaniasis, as PKDL is a sequelae of this disease. This can be achieved through vector control measures and early diagnosis and treatment of visceral leishmaniasis.

See Also

• Leishmaniasis
• Visceral leishmaniasis
• Cutaneous leishmaniasis