Abstract
Post kala-azar dermal leishmaniasis (PKDL) cases play a vital role in maintaining the parasite reservoir during interepidemic periods of visceral leishmaniasis. Timely diagnosis and treatment of PKDL cases are paramount in achieving sustained kala-azar elimination. Diagnosis of PKDL remains a major challenge due to sparse parasite loads, especially in macular cases. A substantial number of PKDL cases are misdiagnosed at primary health centers. Conventional methods of parasite detection such as stained smears, histopathology, and culture have low sensitivity and require invasive procedures. Due to the persistence of antileishmanial antibodies after VL, serological tests such as DAT, ELISA, and rK-39 are inconclusive for diagnosis of PKDL. PCR, real-time PCR, and isothermal assays, among others, have overcome these limitations being highly sensitive and specific nucleic acid–based tests. For an accurate and rapid diagnosis of PKDL, loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA) have been used. Such assays can be used to assess the efficacy of new antileishmanial drugs and to assess the effectiveness of cures. The standard treatment for PKDL still needs improvement. The oral drug miltefosine was introduced as a first-line treatment due to increased resistance to antimonials. With miltefosine monotherapy, PKDL relapses have increased, indicating the need for more robust regimens based on other drugs and combinations. We will discuss various approaches to diagnosing and treating this disease.
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Azam, M., Ramesh, V., Salotra, P., Singh, R. (2023). Post Kala-Azar Dermal Leishmaniasis: Diagnosis and Treatment. In: Selvapandiyan, A., Singh, R., Puri, N., Ganguly, N.K. (eds) Challenges and Solutions Against Visceral Leishmaniasis. Springer, Singapore. https://doi.org/10.1007/978-981-99-6999-9_6
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