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      Post-Kala-Azar Dermal Leishmaniasis as a Reservoir for Visceral Leishmaniasis Transmission

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          Abstract

          Post-kala-azar dermal leishmaniasis (PKDL) is a parasitic skin infection which can occur after visceral leishmaniasis (VL). Recent xenodiagnosis studies (Mondal et al., Clin. Infect. Dis., 2018) have uncovered the infectiousness of PKDL. When including this in a transmission model, PKDL cases appear as an important reservoir of infection, likely frustrating the VL elimination efforts on the Indian subcontinent.

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          Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies

          Dinesh Mondal, Caryn Bern, Debashis Ghosh … (2018)
          We report xenodiagnosis results for 47 post-kala-azar dermal leishmaniasis (PKDL) and 15 visceral leishmaniasis (VL) patients. Skin parasite load was strongly associated with positive xenodiagnosis. Compared to VL (66.7%), nodular PKDL was more likely (86%) and macular PKDL less likely (35%) to result in positive xenodiagnosis.
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            Longlasting insecticidal nets for prevention of Leishmania donovani infection in India and Nepal: paired cluster randomised trial

            Albert Picado, Shri Prakash Singh, Suman Rijal … (2010)
            Objective To test the effectiveness of large scale distribution of longlasting nets treated with insecticide in reducing the incidence of visceral leishmaniasis in India and Nepal. Design Paired cluster randomised controlled trial designed to detect a 50% reduction in incidence of Leishmania donovani infection. Setting Villages in Muzaffarpur district in India and Saptari, Sunsari, and Morang districts in Nepal. Participants 13 intervention and 13 control clusters. 12 691 people were included in the analysis of the main outcome (infection), and 19 810 were enrolled for the secondary (disease) end point. Intervention Longlasting insecticidal nets (treated with deltamethrin) were distributed in the intervention clusters in December 2006. Main outcome measures Infection was determined by direct agglutination test at 12 and 24 months after the intervention in those who had negative results (titre <1:1600) at baseline. The effect estimate was computed as the geometric mean of the risk ratios for seroconversion for each cluster pair (net/no net), with its 95% confidence interval. Formal tests of effect of no intervention were obtained with a paired t test. Results There was no significant difference in the risk of seroconversion over 24 months in intervention (5.4%; 347/6372) compared with control (5.5%; 345/6319 people) clusters (risk ratio 0.90, 95% confidence interval 0.49 to 1.65) nor in the risk of clinical visceral leishmaniasis (0.99, 0.46 to 1.40). Adjustment for covariates did not alter these conclusions. Conclusions There is no evidence that large scale distribution of longlasting insecticidal nets provides additional protection against visceral leishmaniasis compared with existing control practice in the Indian subcontinent. The observed effect was small and not significant, though the confidence intervals did not exclude a 50% change in either direction. Trial registration Clinical Trials NCT 2005-015374.
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              Report of the Post Kala-Azar Dermal Leishmaniasis (PKDL) consortium meeting, New Delhi, India, 27–29 June 2012

              Philippe Desjeux, Raj Ghosh, Pritu Dhalaria … (2013)
              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.
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                Author and article information

                Contributors
                Epke A. Le Rutte
                Journal
                Journal ID (nlm-ta): Trends Parasitol
                Journal ID (iso-abbrev): Trends Parasitol
                Title: Trends in Parasitology
                Publisher: Elsevier Science
                ISSN (Print): 1471-4922
                ISSN (Electronic): 1471-5007
                Publication date PMC-release: 1 August 2019
                Publication date (Print): August 2019
                Volume: 35
                Issue: 8
                Pages: 590-592
                Affiliations
                [1 ]Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
                [2 ]Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel 4002, Switzerland
                [3 ]University of Basel, Basel 4003, Switzerland
                [4 ]Rotterdam Centre for Tropical Medicine, Bovenstraat 21, 3077 BB Rotterdam, The Netherlands
                Author notes
                Article
                Publisher ID: S1471-4922(19)30139-4
                DOI: 10.1016/j.pt.2019.06.007
                PMC ID: 6667731
                PubMed ID: 31266711
                SO-VID: dcc6e982-4167-4440-ae8a-0f0943559cac
                Copyright © © 2019 The Authors
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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                Subject: Article

                ScienceOpen disciplines: Parasitology
                Keywords: post-kala-azar dermal leishmaniasis (pkdl),visceral leishmaniasis,elimination,transmission dynamics,xenodiagnosis
                Data availability:
                ScienceOpen disciplines: Parasitology
                Keywords: post-kala-azar dermal leishmaniasis (pkdl), visceral leishmaniasis, elimination, transmission dynamics, xenodiagnosis

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