Ghosh Debashis, Sagar Soumik Kha, Uddin Md Rasel, Rashid Md Utba, Maruf Shomik, Nath Rupen, Islam Md Nazmul, Aktaruzzaman M M, Sohel Abu Nayeem Mohammad, Banjara Megha Raj, Kroeger Axel, Aseffa Abraham, Mondal Dinesh
Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.
Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
Int J Infect Dis. 2024 Oct;147:107213. doi: 10.1016/j.ijid.2024.107213. Epub 2024 Aug 22.
As post kala-azar Dermal Leishmaniasis (PKDL) threatens the success of the Visceral Leishmaniasis (VL) elimination initiative, we aimed to investigate the PKDL burden, including an active search for PKDL in leprosy-negative skin lesion cases. We also investigated their health-seeking behavior and perceived level of stigma.
This was a cross-sectional survey among inhabitants in the VL-endemic villages of the five most VL-endemic upazilas. VL experts trained medical officers in Upazila Health Complexes (UHCs) and leprosy facilities in PKDL management. Frontline workers conducted house-to-house surveys, referring PKDL suspects to designated centers. Data analysis involved Epi Info version 7 and IBM SPSS Statistics 25.
Among 472,435 screened individuals, 4022 had past VL (0.85 %). Among the screened population, 82 were PKDL suspects, and 62 PKDL cases were confirmed. The overall PKDL burden was 1.3 (95 % CI: 1.0-1.7) in the 10,000 population in the endemic villages. Male predominance and macular form of PKDL were observed. Thirty-nine PKDL patients perceived stigma of different levels. Only 27 of 62 (44 %) had received PKDL treatment. Medicine's unavailability and side effects were a major reason behind treatment interruption. Active screening among 137 leprosy-negative PKDL suspects yielded 10 (7.3 %) PKDL cases.
The existence of PKDL cases in the VL endemic areas is a concern as those are inter-epidemic reservoirs. As per the WHO roadmap, the PKDL burden must be reduced by 70 % and 100 %, respectively, by 2026 and 2030. NKEP can take the current burden of 1.3 per 10,000 people in VL endemic villages as a baseline. Integrating active case detection for PKDL in leprosy hospitals and screening centers is feasible and worth deploying nationwide.
由于黑热病后皮肤利什曼病（PKDL）威胁到内脏利什曼病（VL）消除计划的成功，我们旨在调查PKDL负担，包括在麻风阴性皮肤病变病例中积极搜寻PKDL。我们还调查了他们的就医行为和感知到的耻辱程度。
这是一项对五个VL流行最严重的乌帕齐拉的VL流行村庄居民进行的横断面调查。VL专家在乌帕齐拉卫生中心（UHC）培训医务人员，并在PKDL管理方面培训麻风病防治机构的人员。一线工作人员进行挨家挨户的调查，将PKDL疑似病例转诊至指定中心。数据分析使用Epi Info 7版和IBM SPSS Statistics 25。
在472435名接受筛查的个体中，有4022人曾患VL（0.85%）。在筛查人群中，有82人是PKDL疑似病例，确诊了62例PKDL病例。流行村庄每10000人中PKDL的总体负担为1.3（95%CI：1.0 - 1.7）。观察到PKDL以男性为主且呈斑疹型。39名PKDL患者感知到不同程度的耻辱。62名患者中只有27名（44%）接受过PKDL治疗。药品短缺和副作用是治疗中断的主要原因。对137名麻风阴性PKDL疑似病例进行的主动筛查发现了10例（7.3%）PKDL病例。
VL流行地区存在PKDL病例令人担忧，因为这些病例是流行间期的传染源。根据世界卫生组织的路线图，到2026年和2030年，PKDL负担必须分别降低70%和100%。国家消除内脏利什曼病计划（NKEP）可以将VL流行村庄目前每10000人1.3的负担作为基线。在麻风病医院和筛查中心整合PKDL主动病例检测是可行的，值得在全国范围内推广。
