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Proper identification and management of post-kala-azar dermal leishmaniasis (PKDL) and canine leishmaniasis (CanL) cases are among the prerequisites to the effective control of visceral leishmaniasis worldwide. Unlike PKDL, CanL still awaits effective improvement because of its cryptic nature, absence of parasites in lesions or lymph nodes and not complete sensitivity of some diagnostic tools in use. Because of the need for certain skills and equipment, both the liquid direct agglutination test and freeze-dried direct agglutination test (FD-DAT) versions are, in comparison with the indirect immunofluorescence antibody test (IFAT) or enzyme-linked immunosorbent assay (ELISA), practical and feasible diagnostic alternatives.

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Post-kala-azar dermal leishmaniasis (PKDL) is a neglected skin disease that has tremendous epidemiological significance as a reservoir of Leishmania parasites. Relapse, drug resistance, non-compliance to prolonged treatment, poor health-seeking behaviour, along with limited therapeutic options pose a significant impact on the management of PKDL. In this study, we aimed to review the efficacy, safety and tolerability data of combination therapies for PKDL in the published literature.

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Article Synopsis
  • Post Kala-azar Dermal Leishmaniasis (PKDL) emerges as a complication of visceral leishmaniasis (VL), posing challenges for disease management and ongoing elimination efforts due to its potential for ongoing transmission.
  • In this study, researchers assessed neutrophils in PKDL patients' skin biopsies, finding increased numbers of activated neutrophils and elevated levels of inflammatory markers compared to healthy controls.
  • The findings suggest that activated neutrophils may significantly influence the inflammatory environment in PKDL, highlighting the need for further understanding of their role in the disease's progression and treatment.
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Atypical cutaneous leishmaniasis: a new challenge to VL elimination in South-East Asia.

Front Cell Infect Microbiol

November 2024

Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada.

Visceral leishmaniasis (VL) caused by in South-East Asian endemic countries including India, Nepal and Bangladesh has been the primary focus of the ongoing VL elimination program. With a major reduction in VL cases resulting from the elimination program during the last two decades, the efforts are now focused on the challenges posed by potential reservoirs within the asymptomatic cases, HIV-co-infection VL cases and Post Kala-azar Dermal Leishmaniasis (PKDL) cases that continue to sustain the parasite transmission cycle in known and newer endemic zones. This article brings attention to a new potential parasite reservoir in the form of atypical cutaneous leishmaniasis (ACL) cases caused by novel genetic variants.

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