Ghosh Pramit, Roy Pritam, Chaudhuri Surya Jyati, Das Nilay Kanti
Department of Community Medicine, Purulia Government Medical College, Purulia, West Bengal, India.
Departments of Community Medicine, Independent Researcher and Public Health Expert, Kolkata, West Bengal, India.
Indian J Dermatol. 2021 Jan-Feb;66(1):12-23. doi: 10.4103/ijd.IJD_651_20.
Post-kala-azar dermal leishmaniasis (PKDL) is a cutaneous sequel of visceral leishmaniasis (VL) or kala-azar and has become an entity of epidemiological significance by virtue of its ability to maintain the disease in circulation during inter-epidemic periods. PKDL has been identified as one of the epidemiological marker of "kala-azar elimination programme." Data obtained in 2018 showed PKDL distribution primarily concentrated in 6 countries, which includes India, Sudan, south Sudan, Bangladesh, Ethiopia, and Nepal in decreasing order of case-burden. In India, PKDL cases are mainly found in 54 districts, of which 33 are in Bihar, 11 in West Bengal, 4 in Jharkhand, and 6 in Uttar Pradesh. In West Bengal the districts reporting cases of PKDL cases include Darjeeling, Uttar Dinajpur, Dakshin Dinajpur, Malda, and Murshidabad. The vulnerability on the young age is documented in various studies. The studies also highlights a male predominance of the disease but recent active surveillance suggested that macular form of PKDL shows female-predominance. It is recommended that along with passive case detection, active survey helps in early identification of cases, thus reducing disease transmission in the community. The in 2017 introduced by Government of India with the goal to eliminate Kala-azar as a public health problem, targets to reduceing annual incidence <1/10,000. is the established causative agent, but others like or may occasionally lead to the disease, especially with HIV-co-infection. Dermal tropism of the parasite has been attributed to overexpression of parasite surface receptors (like gp 63, gp46). Various host factors are also identified to contribute to the development of the disease, including high pretreatment IL 10 and parasite level, inadequate dose and duration of treatment, malnutrition, immuno-suppression, decreased interferon-gamma receptor 1 gene, etc. PKDL is mostly concentrated in the plains below an altitude of 600 mts which is attributed to the environment conducive for the vector sand fly (). Risk factors are also linked to the habitat of the sand fly. Keeping these things in mind "Integrated vector control" is adopted under as one of the strategies to bring down the disease burden.
黑热病后皮肤利什曼病（PKDL）是内脏利什曼病（VL）即黑热病的一种皮肤后遗症，由于其在流行间期能够使疾病持续传播，已成为具有流行病学意义的一个实体。PKDL已被确定为“消除黑热病计划”的流行病学标志之一。2018年获得的数据显示，PKDL的分布主要集中在6个国家，按病例负担递减顺序依次为印度、苏丹、南苏丹、孟加拉国、埃塞俄比亚和尼泊尔。在印度，PKDL病例主要分布在54个区，其中比哈尔邦有33个，西孟加拉邦有11个，贾坎德邦有4个，北方邦有6个。在西孟加拉邦，报告有PKDL病例的区包括大吉岭、北迪纳杰布尔、南迪纳杰布尔、马尔达和穆尔希达巴德。多项研究记录了该病在年轻人中的易感性。这些研究还强调了该病男性居多，但最近的主动监测表明，斑疹型PKDL以女性居多。建议除了被动病例检测外，主动调查有助于早期发现病例，从而减少社区内的疾病传播。印度政府于2017年推出了以消除黑热病这一公共卫生问题为目标的计划，目标是将年发病率降低至<1/10000。杜氏利什曼原虫是已确定的病原体，但其他病原体如婴儿利什曼原虫或热带利什曼原虫偶尔也可能导致该病，尤其是在合并感染HIV的情况下。寄生虫的皮肤嗜性归因于寄生虫表面受体（如gp 63、gp46）的过度表达。还确定了多种宿主因素对该病的发生发展有影响，包括治疗前白细胞介素10和寄生虫水平高、治疗剂量和疗程不足、营养不良、免疫抑制、干扰素-γ受体1基因减少等。PKDL大多集中在海拔600米以下的平原地区，这归因于有利于媒介白蛉生存的环境。风险因素也与白蛉的栖息地有关。考虑到这些因素，在该计划下采用了“综合病媒控制措施”作为减轻疾病负担的策略之一。
