Abstract

Post-kala-azar dermal leishmaniasis (PKDL) is a macular, papular, and/or nodular skin rash that can appear as a sequel of visceral leishmaniasis (VL) caused by Leishmania donovani. In Bangladesh, it occurs in around 10% of VL patients, leading to high prevalences of 6/10,000–21/10,000 population in endemic regions [1,2]. Over 95% of lesions are macular and cause no or little physical discomfort to patients. However, Leishmania parasites can been found in PKDL lesions, and there is (sparse) evidence that they are infective to sandflies [3,4,5]. It is generally assumed that PKDL patients form an infectious reservoir and should be treated in order to achieve disease control. There are no evidence-based treatments for PKDL. Therefore, treatment can be considered experimental, and treatment choices are ‘‘best guesses’’ based on good results in small clinical studies and clinical experience in the field.

Médecins Sans Frontières provides treatment for VL and PKDL in Fulbaria, a highly endemic subdistrict of Mymensingh in Bangladesh.

Authors

Ulrika Marking, Margriet den Boer, Asish Kumar Das, Elshafie Mohamed Ahmed, Victoria Rollason, Be-Nazir Ahmed, Robert N. Davidson, Koert Ritmeijer