TMSS Medical College Journal

Background:Post-kala-azar dermal leishmaniasis (PKDL)has important public health implications for transmission of visceral leishmaniasis (VL)or Kala-Azar commonly found in endemic area of Bangladesh Elimination and prevention of VL requires detection and identification of risk factors and treatment of PKDL cases,necessarily because of its capacity to serve as a reservoir for the causative parasite,Leishmania donovani. Objeetive:To find out sociodemographic factors in different clinical patter of PKDL cases in endemic area of Bangladesh.Methodology:This Observational study will explore the socio-demographic factors in different clinical forms for control of kala-azar in endemic area of Bangladesh.The cases will be enrolled from Valuka, Haluaghat,Trishal and other Upazilla health complexes of Mymensingh district and OPD of MMCH and CBMCH.Results:Clinical and epidemiologic profiles of 91 PKDL patients showed that median age of males and females at the time of diagnosis was significantly different(P=0.013).A significant association was observed between family history of VL and sex of PKDL patients (x2=5.72,P<0.01).Nearly 85%of the patients showed development of PKDL within five year of VL treatment.The observed time (median=2.5 year) between appearance of lesions and diagnosis is an important factor in VL transmission.A significant association was observed between type of lesions and duration of appearance after VL treatment (x2=6.59,P 0.001). Conclusion:PKDL was observed after a long period of treatment.Identification and remove the sociodemographic factors like housing condition,incomplete treatment and reservoir are important factor in the public health importance of patients with PKDL in terms of transmission of infection in the community.

Post-kala-azar dermal leishmaniasis (PKDL)is a dermatropic form of leishmaniasis caused by Leishmania donovani parasites infection in the skin after apparently successful treatment of patients with visceral leishmaniasis (VL)or those without a history of VL.It is characterized by macular,maculopapular,and nodular lesions in patients recovering from VL who are otherwise healthyl.It occurs in nearly 10-20%of patients cured of VL within 1-5 years in Indian subcontinent,and in approximately 50%of patients in Sudan within six months1-4.In Bangladesh PKDL cases also increase gradually Patients with PKDL have immense public health importance because they act as reservoirs of infection5.Because there is no animal reservoir of L.donovani,in this sub-continent,it is important to detect patients with PKDL and their risk factors and treat them properly and remove these risk factors to prevent future outbreaks of VL7.PKDL can easily be confused with a number of skin disorders such as leprosy,psoriasis and eczema. Clinical similarities between the skin lesions of PKDL and leprosy may lead to diagnostic difficulties,especially in areas where the diseases are coendemic4.A patient is diagnosed as having PKDL if the following features are present: history of treatment kala-azar (present in 85% cases);presence of macules,papules or nodules without any loss of sensation over the lesions;and a positive rK39 dipstick test