Clinical and immunological aspects of post-kala-azar dermal leishmaniasis in Bangladesh

We conducted active surveillance for kala-azar and post-kala-azar dermal leishmaniasis (PKDL) in a population of 24,814 individuals. Between 2002 and 2010, 1,002 kala-azar and 185 PKDL cases occurred. Median PKDL patient age was 12 years; 9% had no antecedent kala-azar. Cases per 10,000 person-years...

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Bibliographic Details
Published in:The American journal of tropical medicine and hygiene 2013-08, Vol.89 (2), p.345-353
Main Authors: Islam, Shamim, Kenah, Eben, Bhuiyan, Mohammed Ashraful Alam, Rahman, Kazi Mizanur, Goodhew, Brook, Ghalib, Chowdhury Mohammad, Zahid, M M, Ozaki, Masayo, Rahman, M W, Haque, Rashidul, Luby, Stephen P, Maguire, James H, Martin, Diana, Bern, Caryn
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Antiprotozoal Agents - therapeutic use
Bangladesh - epidemiology
Child
Child, Preschool
Collagenases - blood
Cytokines - blood
Female
Humans
Incidence
Leishmaniasis, Cutaneous - drug therapy
Leishmaniasis, Cutaneous - epidemiology
Leishmaniasis, Cutaneous - immunology
Leishmaniasis, Cutaneous - pathology
Leishmaniasis, Visceral - complications
Leishmaniasis, Visceral - drug therapy
Leishmaniasis, Visceral - epidemiology
Male
Matrix Metalloproteinase Inhibitors - blood
Middle Aged
Risk Factors
Young Adult
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Summary:We conducted active surveillance for kala-azar and post-kala-azar dermal leishmaniasis (PKDL) in a population of 24,814 individuals. Between 2002 and 2010, 1,002 kala-azar and 185 PKDL cases occurred. Median PKDL patient age was 12 years; 9% had no antecedent kala-azar. Cases per 10,000 person-years peaked at 90 for kala-azar (2005) and 28 for PKDL (2007). Cumulative PKDL incidence among kala-azar patients was 17% by 5 years. Kala-azar patients younger than 15 years were more likely than older patients to develop PKDL; no other risk factors were identified. The most common lesions were hypopigmented macules. Of 98 untreated PKDL patients, 48 (49%) patients had resolution, with median time of 19 months. Kala-azar patients showed elevated interferon-γ (IFNγ), tumor necrosis factor-α (TNFα), and interleukin 10 (IL-10). Matrix metalloproteinase 9 (MMP9) and MMP9/tissue inhibitor of matrix metalloproteinase-1 (TIMP1) ratio were significantly higher in PKDL patients than in other groups. PKDL is frequent in Bangladesh and poses a challenge to the current visceral leishmaniasis elimination initiative in the Indian subcontinent.
ISSN:0002-9637
1476-1645
DOI:10.4269/ajtmh.12-0711