International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Curr Opin Infect Dis. 2011 Oct;24(5):418-22. doi: 10.1097/QCO.0b013e32834a8ba1.
Post-kala-azar dermal leishmaniasis (PKDL) is a challenge for clinicians and researchers, because its burden is poorly investigated and pathogenesis is disputable. However, recent studies contributed to understanding of the pathogenesis of PKDL especially its association with host immunological factors, and also how to improve its diagnosis and treatment. This review focuses on recent advances in diagnosis, new insights into pathogenesis and case management.
Information regarding the burden of PKDL, especially in Bangladesh, is now available. Association between skin parasite burden and different clinical forms of PKDL has been explored. The diagnostic importance of detection of Leishmania donovani DNA in the peripheral blood buffy coat and in skin specimens by PCR has been studied. Variable effects of different antileishmanial drugs on immune response have been observed. Finally, high efficacy of miltefosine for treatment of PKDL has been demonstrated.
The incidence of PKDL is reducing in India after introduction of miltefosine and amphotericin B for treatment of visceral leishmaniasis. It remains higher in Bangladesh and in Sudan. Parasite burden is higher in nodular and papular forms of PKDL compared to the macular form of the disease. The demonstration of Leishmania DNA in peripheral blood buffy coat and in skin specimens can help to diagnose 40-75% clinically suspected PKDL individuals. An initial cure rate of 95% has been achieved with miltefosine for treatment of PKDL. However, the efficacy of combination therapy should be explored to reduce the treatment duration and hence to improve treatment compliance.
内脏利什曼病（黑热病）采用米替福新和两性霉素 B 治疗后，印度的皮肤利什曼病（黑热病后皮肤炎）发病率降低。然而在孟加拉国和苏丹，其发病率仍居高不下。与疾病的黄斑形式相比，结节性和丘疹性皮肤利什曼病的寄生虫负担更高。在外周血涂片和皮肤标本中检测到利什曼原虫 DNA 有助于诊断 40-75%临床疑似皮肤利什曼病患者。米替福新治疗皮肤利什曼病的初始治愈率为 95%。然而，应该探索联合治疗的疗效，以缩短治疗时间，从而提高治疗依从性。
