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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 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.
Author Notes
Financial support: This study was supported by US Agency for International Development/Centers for Disease Control and Prevention Interagency Agreement OGH06-006. E.K.'s participation was funded by National Institutes of Health Grant F32GM085945.
Authors' addresses: Shamim Islam, Children's Hospital and Research Center Oakland, Oakland, CA, E-mail: sizuba@yahoo.com. Eben Kenah, University of Florida, Gainesville, FL, E-mail: ekenah@ufl.edu. Mohammed Ashraful Alam Bhuiyan, Kazi Mizanur Rahman, Chowdhury Mohammad Ghalib, M. M. Zahid, M. W. Rahman, and Rashidul Haque, icddr,b, Dhaka, Bangladesh, E-mails: aabhuiyan@icddrb.org, mizan@icddrb.org, kutshit@yahoo.com, zahid@icddrb.org, mwrahman@gmail.com, and rhaque@icddrb.org. Brook Goodhew and Diana Martin, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: isd6@cdc.gov and hzx3@cdc.gov. Masayo Ozaki, University of Alabama, Birmingham, AL, E-mail: masayo.ozaki@gmail.com. Stephen P. Luby, Stanford University, Palo Alto, CA, E-mail: sluby@stanford.edu. James H. Maguire, Brigham and Women's Hospital, Boston, MA, E-mail: JMaguire@partners.org. Caryn Bern, University of California, San Francisco, CA, E-mail: Caryn.Bern2@UCSF.EDU.