Diagnosis of post kala azar dermal leishmaniasis in nonendemic Areas: A clinical challenge

Abstract

Leishmaniasis is a heterogeneous group of disease caused by protozoans of the genus Leishmania, transmitted by Phlebotomus sandflies. Human leishmaniasis is usually classified as visceral, cutaneous (localized, diffuse, disseminated), mucocutaneous, and post-kala-azar leishmaniasis. Post-kala-azar leishmaniasis is a sequel of visceral leishmaniasis (VL) caused by Leishmania donovani (LD) and seen in India, Bangladesh, Nepal, and Sudan. In India, it develops in 5%–15% of treated VL cases within 2–5 years. It is characterized by multiple papular, nodular, and pleomorphic lesions over the sun-exposed areas such as face, neck, and arms, without systemic manifestations. It mimics a wide range of dermatoses, particularly leprosy in endemic areas for both the diseases. Inadequate immune response (Th1 and Th2) to infection during and after the treatment of VL plays a role in the pathogenesis. It is thought to be a good reservoir of LD and plays an important role in the treatment of VL. Post-kala-azar dermal leishmaniasis (PKDL) is usually diagnosed by skin smears, immunological tests such as rK39, cutaneous leishmaniasis detection tests, and polymerase chain reaction. A combination of liposomal amphotericin B and miltefosine is the first line of treatment. PKDL is a forgotten clinical entity in the nonendemic areas. We report a case of PKDL in a 52-year-old male from Andhra Pradesh, a nonendemic area for leishmaniasis. This case was treated successfully with combination therapy, liposomal amphotericin B, and miltefosine.

Keywords

• amphotericin b
• miltefosine
• pathogenesis
• polymerase chain reaction assays
• post-kala-azar dermal leishmaniasis