Video:Post-kala-azar dermal leishmaniasis

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Post-kala-azar dermal leishmaniasis is a complication following visceral leishmaniasis characterized by white areas of skin.[1] Treatment is often with miltefosine, sodium stibogluconate or amphotericin B.[1] PKDL mainly occurs in Sudan and India, which are areas affected by Leishmania donovani.[1]


The presentation consists of areas of decreased pigment, red succulent raised areas, nodular lesions, sensitivity to sunlight, verrucous, xanthomatous and ulcerative lesions.[2][3]


The cause is uncertain. Possible reasons include use of antimonial drugs, reinfection with kala-azar and memory T cell responses failing.[4][5]


There evidence that the pathogenesis is largely immunologically mediated; high concentrations of interleukin 10 in the peripheral blood predict the development of PKDL.[6][4]


Diagnosis is mainly based on symptoms, but parasites can be seen by microscopy in smears with limited sensitivity.[7] Polymerase chain reaction and monoclonal antibodies may detect parasites in a high percentage of cases. Serological tests and the leishmanin skin test are of limited value.[8][9][10]


In terms of management, 12 weeks of oral miltefosine is given, with dosage adjustments per age and weight.[11]


Post-kala-azar dermal leishmaniasis occurs in Asia and Africa: specifically India 75 percent, Bangladesh 7 percent, Sudan 9 percent, South Sudan 8 percent, and Bangladesh 7 percent.[12]


  1. 1.0 1.1 1.2 Passeron, Thierry; Ortonne, Jean-Paul (2016). "Kala-azar". Atlas of Pigmentary Disorders. Switzerland: Springer. p. 144. ISBN 978-3-319-10897-1. Archived from the original on 12 July 2023. Retrieved 11 July 2023.
  2. Prevention, CDC-Centers for Disease Control and (13 June 2023). "CDC - Leishmaniasis - Resources for Health Professionals". Archived from the original on 23 April 2023. Retrieved 15 July 2023.
  3. Kumar, P; Chatterjee, M; Das, NK (January 2021). "Post Kala-Azar Dermal Leishmaniasis: Clinical Features and Differential Diagnosis". Indian journal of dermatology. 66 (1): 24–33. doi:10.4103/ijd.IJD_602_20. PMID 33911290.
  4. 4.0 4.1 Mukhopadhyay, D; Dalton, JE; Kaye, PM; Chatterjee, M (February 2014). "Post kala-azar dermal leishmaniasis: an unresolved mystery". Trends in parasitology. 30 (2): 65–74. doi:10.1016/ PMID 24388776.
  5. Gedda, Mallikarjuna Rao; Singh, Bhawana; Kumar, Dhiraj; Singh, Abhishek Kumar; Madhukar, Prasoon; Upadhyay, Shreya; Singh, Om Prakash; Sundar, Shyam (2 July 2020). "Post kala-azar dermal leishmaniasis: A threat to elimination program". PLOS Neglected Tropical Diseases. 14 (7): e0008221. doi:10.1371/journal.pntd.0008221. ISSN 1935-2735.
  6. Volpedo, G; Pacheco-Fernandez, T; Holcomb, EA; Cipriano, N; Cox, B; Satoskar, AR (2021). "Mechanisms of Immunopathogenesis in Cutaneous Leishmaniasis And Post Kala-azar Dermal Leishmaniasis (PKDL)". Frontiers in cellular and infection microbiology. 11: 685296. doi:10.3389/fcimb.2021.685296. PMID 34169006.
  7. Zijlstra, EE (2019). "Biomarkers in Post-kala-azar Dermal Leishmaniasis". Frontiers in cellular and infection microbiology. 9: 228. doi:10.3389/fcimb.2019.00228. PMID 31417876.
  8. Dixit, KK; Singh, R; Salotra, P (November 2020). "Advancement in Molecular Diagnosis of Post Kala-Azar Dermal Leishmaniasis". Indian Journal of Dermatology. 65 (6): 465–472. doi:10.4103/ijd.IJD_311_19 (inactive 2023-07-13). PMC 7810074. PMID 33487701.{{cite journal}}: CS1 maint: DOI inactive as of July 2023 (link)
  9. Bhandare, P; Shukla, P; Bhobe, M; Pai, VV (December 2014). "Post-kala-Azar dermal leishmaniasis: A diagnostic dilemma in a nonendemic area". Indian Dermatology Online Journal. 5 (Suppl 2): S122-4. doi:10.4103/2229-5178.146190. PMC 4290175. PMID 25593802.
  10. Zijlstra, Ee; Musa, Am; Khalil, Eag; El Hassan, Im; El-Hassan, Am (February 2003). "Post-kala-azar dermal leishmaniasis". The Lancet Infectious Diseases. 3 (2): 87–98. doi:10.1016/S1473-3099(03)00517-6. Archived from the original on 20 November 2022. Retrieved 16 July 2023.
  11. "Leishmaniasis - India". Retrieved 14 May 2024.
  12. Ghosh, Pramit; Roy, Pritam; Chaudhuri, Surya Jyati; Das, Nilay Kanti (2021). "Epidemiology of Post-Kala-azar Dermal Leishmaniasis". Indian Journal of Dermatology. 66 (1): 12–23. doi:10.4103/ijd.IJD_651_20. ISSN 1998-3611. PMC 8061485. PMID 33911289.