Post kala-azar dermal leishmaniasis: an unresolved mystery

Trends Parasitol. 2014 Feb;30(2):65-74. doi: 10.1016/j.pt.2013.12.004. Epub 2014 Jan 2.

Abstract

Post kala-azar dermal leishmaniasis (PKDL), a cutaneous sequela of visceral leishmaniasis (VL), develops in some patients alongside but more commonly after apparent cure from VL. In view of the pivotal role of PKDL patients in the transmission of VL, here we review clinical, epidemiological, parasitological, and immunological perspectives of this disease, focusing on five hypotheses to explain the development of PKDL: (i) the role of antimonial drugs; (ii) UV-induced skin damage; (iii) reinfection; (iv) organ specific failure of memory T cell responses; and (v) genetic susceptibility of the host. This review will enable researchers and clinicians to explore the unresolved mystery of PKDL and provide a framework for future application of 'omic' approaches for the control and eventual elimination of VL.

Keywords: UV light; antimony; post kala-azar dermal leishmaniasis (PKDL); regulatory T cells; vitamin D.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antimony / pharmacology
  • Antiprotozoal Agents / adverse effects
  • Antiprotozoal Agents / therapeutic use
  • Genetic Predisposition to Disease
  • Humans
  • Leishmaniasis, Cutaneous / drug therapy
  • Leishmaniasis, Cutaneous / epidemiology
  • Leishmaniasis, Cutaneous / immunology*
  • Leishmaniasis, Cutaneous / parasitology*
  • T-Lymphocytes / immunology
  • Ultraviolet Rays

Substances

  • Antiprotozoal Agents
  • Antimony