Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India.
Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India.
Indian J Dermatol Venereol Leprol. 2022 Mar-Apr;88(2):201-206. doi: 10.25259/IJDVL_338_20.
Post kala-azar dermal leishmaniasis (PKDL) is thought to be the reservoir of infection for visceral leishmaniasis in South Asia. The development of strategies for the diagnosis and treatment of PKDL are important for the implementation of the visceral leishmaniasis elimination program.
Liposomal amphotericin B (L-AMB) has been an overwhelming success in the treatment of visceral leishmaniasis. However, the empirical three-week regimen of L-AMB proposed for PKDL was shown to be inadequate, especially in the macular variant. This study aimed to delineate response of the different variants of PKDL to L-AMB.
Skin biopsies were collected from PKDL cases at disease presentation and upon completion of treatment with L-AMB. Parasite DNA was detected by Internal Transcribed Spacer-1 PCR (ITS-1 PCR) and quantified by amplification of parasite kDNA. CD68 + macrophages were estimated in tissue sections by immunohistochemistry.
Treatment with L-AMB decreased the parasite load by 97% in polymorphic cases but only by 45% in macular cases. The median parasite load (89965 vs 5445 parasites/μg of genomic DNA) as well as infiltration by CD68+ cells before treatment was much greater in the polymorphic cases.
Although monitoring of the parasite load for 12 months post-treatment would have been ideal, this was not possible owing to logistical issues as well as the invasive nature of biopsy collection procedure.
A dramatic decrease in the parasite burden was noted in patients with polymorphic lesions. Although patients with macular disease also had a decrease in parasite burden, this was not as marked as in the polymorphic cases. There was also a significantly greater infiltration of CD68 + macrophages in polymorphic PKDL before therapy.
利什曼原虫病后皮肤利什曼病（PKDL）被认为是南亚内脏利什曼病的感染源。 制定 PKDL 的诊断和治疗策略对于实施内脏利什曼病消除计划非常重要。
脂质体两性霉素 B（L-AMB）在治疗内脏利什曼病方面取得了巨大成功。 然而，针对 PKDL 提出的经验性三周 L-AMB 疗程被证明是不够的，尤其是在黄斑变异型中。 本研究旨在描述不同 PKDL 变异型对 L-AMB 的反应。
在疾病发作时和用 L-AMB 完成治疗后，从 PKDL 病例中采集皮肤活检。 通过内部转录间隔 1 PCR（ITS-1 PCR）检测寄生虫 DNA，并通过寄生虫 kDNA 的扩增来定量。 通过免疫组织化学在组织切片中估计 CD68+巨噬细胞。
L-AMB 治疗使多形性病例中的寄生虫负荷减少了 97%，但在黄斑病例中仅减少了 45%。 治疗前，多形性病例的寄生虫负荷中位数（89965 与 5445 寄生虫/μg 基因组 DNA）以及 CD68+细胞浸润量都要大得多。
尽管对治疗后 12 个月的寄生虫负荷进行监测是理想的，但由于后勤问题以及活检采集程序的侵入性，这是不可能的。
多形性病变患者的寄生虫负担明显下降。 尽管黄斑病患者的寄生虫负荷也有所下降，但不如多形性病例明显。 在治疗前，多形性 PKDL 中 CD68+巨噬细胞的浸润也明显更多。
