Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Center for Cellular Engineering, NIH Clinical Center, Bethesda, Maryland, United States of America.
PLoS Negl Trop Dis. 2020 Jul 2;14(7):e0008221. doi: 10.1371/journal.pntd.0008221. eCollection 2020 Jul.
Leishmaniasis remains a public health concern around the world that primarily affects poor folks of the developing world spanning across 98 countries with mortality of 0.2 million to 0.4 million annually. Post kala-azar dermal leishmaniasis (PKDL) is the late skin manifestation of visceral leishmaniasis (VL). It has been reported that about 2.5% to 20% of patients recovered from VL develop PKDL having stilted macular or nodular lesions with parasites. In the Indian subcontinent (ISC), it manifests a few months after recovery from VL, though in Africa it can occur simultaneously with VL or a little later. New cases of PKDL are also observed without prior VL in the ISC. These individuals with PKDL represent an important but largely neglected reservoir of infection that perpetuates anthroponotic Leishmania donovani transmission in the ISC and can jeopardize the VL elimination program as these cases can infect the sand flies and spread the endemic. Therefore, it becomes imperative to eradicate PKDL as a part of the VL elimination program. With the limited treatment options besides little knowledge on PKDL, this review stands out in focusing on different aspects that should be dealt for sustained VL elimination.
利什曼病仍然是全世界的一个公共卫生关注点，主要影响发展中国家的贫困人群，涉及 98 个国家，每年的死亡率为 0.2 至 0.4 百万。黑热病后皮肤利什曼病（PKDL）是内脏利什曼病（VL）的晚期皮肤表现。据报道，大约 2.5%至 20%从 VL 中康复的患者会出现 PKDL，表现为静止性斑疹或结节性病变和寄生虫。在印度次大陆（ISC），它在 VL 康复后的几个月出现，尽管在非洲，它可能与 VL 同时发生或稍晚一些。ISC 也观察到没有先前 VL 的新 PKDL 病例。这些患有 PKDL 的人是一个重要但在很大程度上被忽视的感染源，它在 ISC 中维持了人源利什曼原虫的传播，并可能危及 VL 消除计划，因为这些病例可以感染沙蝇并传播地方性疾病。因此，作为 VL 消除计划的一部分，消除 PKDL 迫在眉睫。除了对 PKDL 的了解甚少外，治疗选择有限，因此本次综述着重关注应处理的不同方面，以实现 VL 的持续消除。
