Diagnosis & treatment of PKDL

In this step, we visit a South Asian (Indian) perspective on the diagnosis and treatment of post- kala azar dermal leishmaniasis (PKDL) with two experts in the disease: Professor (Dr) Mitali Chatterjee from the Post-Graduate Medical Institute and Professor (Dr) Nilay Kanti Das from the Bankura Sammilani Medical College.

PKDL lesions usually first appear around the mouth and chin. The presence of Leishmania donovani parasites is confirmed by parasitological diagnosis, usually by examining skin slit material under a microscope. Particularly when lesions develop with 12 months of a primary VL infection, it is important to diagnose PKDL parasitologically, as circulating antibodies can confound an rK39 test.

Remember that the presentations of PKDL in the Indian Sub-continent and East Africa are similar. However there are differences in the conditions under which symptoms may develop (e.g. length of time after a VL infection) and in the total numbers of PKDL patients per region. In general, a higher percentage of VL patients develop PKDL in East Africa in a shorter time period than in South Asia ^[1].

PKDL patients are hard to treat and the recommended drugs are sodium stibogluconate (East Africa) and/or AmBisome (South Asia). It is also considered important to treat PKDL patients as they are a possible reservoir of infection – a key factor in an elimination context.