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

Islam, Shamim, Kenah, Eben, Bhuiyan, Mohammed Ashraful Alum, Rahman, Kazi Mizanur, Goodhew, Brook, Ghalib, Chowdhury Mohammed, Zahid, M.M., Ozaki, Masayo, Rahman, M.W., Haque, Rashidul, Luby, Stephen P., Maguire, James H., Martin, Diana, and Bern, Caryn (2013) Clinical and immunological aspects of post–kala-azar dermal leishmaniasis in Bangladesh. American Journal of Tropical Medicine and Hygiene, 89 (2). pp. 345-353.

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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.

Item ID: 54253
Item Type: Article (Research - C1)
ISSN: 1476-1645
Funders: US Agency for International Development (USAID), Centers for Disease Control (CDC), National Institutes of Health (NIH)
Projects and Grants: USAID/CDC Agreement OGH06-006, NIH Grant F32GM085945
Date Deposited: 19 Jul 2018 03:40
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified @ 100%
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