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Post-kala-azar dermal Leishmaniasis in Nepal: a retrospective cohort study (2000-2010)

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dc.contributor.author Uranw, S.
dc.contributor.author Ostyn, B.
dc.contributor.author Rijal, A.
dc.contributor.author Devkota, S.
dc.contributor.author Khanal, B.
dc.contributor.author Menten, J.
dc.contributor.author Boelaert, M.
dc.contributor.author Rijal, S.
dc.date.accessioned 2012-01-17T13:42:36Z
dc.date.available 2012-01-17T13:42:36Z
dc.date.issued 2011
dc.identifier.issn 1935-2727
dc.identifier.doi http://dx.doi.org/10.1371/journal.pntd.0001433
dc.identifier.other ITG-H1B
dc.identifier.other ITG-H2B
dc.identifier.other ITG-I6A
dc.identifier.other ITG-H7A
dc.identifier.other HEALTH
dc.identifier.other U-EPID
dc.identifier.other INTER
dc.identifier.other U-CTU
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other FTA
dc.identifier.other Abstract
dc.identifier.other UPD42
dc.identifier.uri http://hdl.handle.net/10390/6782
dc.description.abstract INTRODUCTION: Post-kala-azar dermal leishmaniasis (PKDL) is a cutaneous complication appearing after treatment of visceral leishmaniasis, and PKDL patients are considered infectious to sand flies and may therefore play a role in the transmission of VL. We estimated the risk and risk factors of PKDL in patients with past VL treatment in south-eastern Nepal. METHODS: Between February and May 2010 we traced all patients who had received VL treatment during 2000-2009 in five high-endemic districts and screened them for PKDL-like skin lesions. Suspected cases were referred to a tertiary care hospital for confirmation by parasitology (slit skin smear (SSS)) and/or histopathology. We calculated the risk of PKDL using Kaplan-Meier survival curves and exact logistic regression for risk factors. RESULTS: Out of 680 past-treated VL patients, 37(5.4%) presented active skin lesions suspect of PKDL during the survey. Thirty-three of them underwent dermatological assessment, and 16 (2.4%) were ascertained as probable (2) or confirmed (14) PKDL. Survival analysis showed a 1.4% risk of PKDL within 2 years of VL treatment. All 16 had been previously treated with sodium stibogluconate (SSG) for their VL. In 5, treatment had not been completed (</=21 injections). Skin lesions developed after a median time interval of 23 months [interquartile range (IQR) 16-40]. We found a higher PKDL rate (29.4%) in those inadequately treated compared to those who received a full SSG course (2.0%). In the logistic regression model, unsupervised treatment [odds ratio (OR) = 8.58, 95% CI 1.21-374.77], and inadequate SSG treatment for VL in the past (OR = 11.68, 95% CI 2.71-45.47) were significantly associated with PKDL. CONCLUSION: The occurrence of PKDL after VL treatment in Nepal is low compared to neighboring countries. Supervised and adequate treatment of VL seems essential to reduce the risk of PKDL development and active surveillance for PKDL is needed. en
dc.language English en
dc.subject Protozoal diseases en
dc.subject Visceral en
dc.subject Leishmaniasis en
dc.subject Kala azar en
dc.subject Leishmania donovani en
dc.subject Vectors en
dc.subject Sandflies en
dc.subject Phlebotomus argentipes en
dc.subject Complications en
dc.subject Cutaneous en
dc.subject Risk factors en
dc.subject Disease transmission en
dc.subject Skin lesions en
dc.subject Treatment outcome en
dc.subject Survival en
dc.subject Disease progression en
dc.subject Nepal en
dc.subject Asia, South en
dc.title Post-kala-azar dermal Leishmaniasis in Nepal: a retrospective cohort study (2000-2010) en
dc.type Article-E en
dc.citation.issue 12 en
dc.citation.jtitle PLoS Neglected Tropical Diseases en
dc.citation.volume 5 en
dc.citation.pages e1433 en
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/22206030
dc.citation.jabbreviation PLoS Negl Trop Dis en


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