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Ghosh D, Sagar SK, Uddin MR, Rashid MU, Maruf S, Nath R, Islam MN, Aktaruzzaman MM, Sohel ANM, Banjara MR, Kroeger A, Aseffa A, Mondal D. Post kala-azar dermal leishmaniasis burden at the village level in selected high visceral leishmaniasis endemic upazilas in Bangladesh. Int J Infect Dis 2024:107213. [PMID: 39179149 DOI: 10.1016/j.ijid.2024.107213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND As post kala-azar Dermal Leishmaniasis (PKDL) threatens the success of the Visceral Leishmaniasis (VL) elimination initiative, we aimed to investigate the PKDL burden, including an active search for PKDL in leprosy-negative skin lesion cases. We also investigated their health-seeking behavior and perceived level of stigma. METHODS This was a cross-sectional survey among inhabitants in the VL-endemic villages of the five most VL-endemic upazilas. VL experts trained medical officers in Upazila Health Complexes (UHCs) and leprosy facilities in PKDL management. Frontline workers conducted house-to-house surveys, referring PKDL suspects to designated centers. Data analysis involved Epi Info version 7 and IBM SPSS Statistics 25. RESULTS Among 472,435 screened individuals, 4022 had past VL (0.85%). Among the screened population, 82 were PKDL suspects, and 62 PKDL cases were confirmed. The overall PKDL burden was 1.3 (95% CI: 1.0-1.7) in the 10,000 population in the endemic villages. Male predominance and macular form of PKDL were observed. 39 PKDL patients perceived stigma of different levels. Only 27 of 62 (44%) had received PKDL treatment. Medicine's unavailability and side effects were a major reason behind treatment interruption. Active screening among 137 leprosy-negative PKDL suspects yielded 10 (7.3%) PKDL cases. CONCLUSIONS The existence of PKDL cases in the VL endemic areas is a concern as those are inter-epidemic reservoirs. As per the WHO roadmap, the PKDL burden must be reduced by 70% and 100%, respectively, by 2026 and 2030. NKEP can take the current burden of 1.3 per 10,000 people in VL endemic villages as a baseline. Integrating active case detection for PKDL in leprosy hospitals and screening centers is feasible and worth deploying nationwide.
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Affiliation(s)
- Debashis Ghosh
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Soumik Kha Sagar
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Md Rasel Uddin
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Md Utba Rashid
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208, USA
| | - Shomik Maruf
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Rupen Nath
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Md Nazmul Islam
- Communicable Disease Control (CDC), Directorate General of Health Services (DGHS), Mohakhali, Dhaka 1212, Bangladesh
| | - M M Aktaruzzaman
- Communicable Disease Control (CDC), Directorate General of Health Services (DGHS), Mohakhali, Dhaka 1212, Bangladesh
| | - Abu Nayeem Mohammad Sohel
- Communicable Disease Control (CDC), Directorate General of Health Services (DGHS), Mohakhali, Dhaka 1212, Bangladesh
| | - Megha Raj Banjara
- UNICEF/UNDP/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland; Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Axel Kroeger
- Centre for Medicine and Society/Institute for Infection Prevention, University Medical Centre, Freiburg, Germany
| | - Abraham Aseffa
- UNICEF/UNDP/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Dinesh Mondal
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
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Arora A, Mohta A. An unusual pediatric case of post kala azar dermal leishmaniasis: A hidden parasite under the veil of white. Clin Microbiol Infect 2023:S1198-743X(23)00118-0. [PMID: 36918142 DOI: 10.1016/j.cmi.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Aakanksha Arora
- Department of Dermatology, Venereology and Leprology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Alpana Mohta
- Department of Dermatology, Venereology and Leprology, Sardar Patel Medical College, Bikaner, Rajasthan, India.
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Gauging the skin resident Leishmania parasites through a loop mediated isothermal amplification (LAMP) assay in post-kala-azar dermal leishmaniasis. Sci Rep 2022; 12:18069. [PMID: 36302782 PMCID: PMC9614002 DOI: 10.1038/s41598-022-21497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/28/2022] [Indexed: 01/24/2023] Open
Abstract
Despite the availability of highly sensitive polymerase chain reaction (PCR)-based methods, the dearth of remotely deployable diagnostic tools circumvents the early and accurate detection of individuals with post-kala-azar dermal leishmaniasis (PKDL). Here, we evaluate a design-locked loop-mediated isothermal amplification (LAMP) assay to diagnose PKDL. A total of 76 snip-skin samples collected from individuals with probable PKDL (clinical presentation and a positive rK39 rapid diagnostic test (RDT)) were assessed by microscopy, qPCR, and LAMP. An equal number of age and sex-matched healthy controls were included to determine the specificity of the LAMP assay. The LAMP assay with a Qiagen DNA extraction (Q-LAMP) showed a promising sensitivity of 72.37% (95% CI: 60.91-82.01%) for identifying the PKDL cases. LAMP assay sensitivity declined when the DNA was extracted using a boil-spin method. Q-qPCR showed 68.42% (56.75-78.61%) sensitivity, comparable to LAMP and with an excellent agreement, whereas the microscopy exhibited a weak sensitivity of 39.47% (28.44-51.35%). When microscopy and/or qPCR were considered the gold standard, Q-LAMP exhibited an elevated sensitivity of 89.7% (95% CI: 78.83-96.11%) for detection of PKDL cases and Bayesian latent class modeling substantiated the excellent sensitivity of the assay. All healthy controls were found to be negative. Notwithstanding the optimum efficiency of the LAMP assay towards the detection of PKDL cases, further optimization of the boil-spin method is warranted to permit remote use of the assay.
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Maruf S, Nath P, Islam MR, Aktar F, Anuwarul A, Mondal D, Basher A. Corneal complications following Post Kala-azar Dermal Leishmaniasis treatment. PLoS Negl Trop Dis 2018; 12:e0006781. [PMID: 30222747 PMCID: PMC6160237 DOI: 10.1371/journal.pntd.0006781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/27/2018] [Accepted: 08/23/2018] [Indexed: 12/21/2022] Open
Abstract
Post Kala-azar Dermal Leishmaniasis (PKDL) is a sequel of Visceral Leishmaniasis (VL). The patients act as a reservoir for the causative parasite (i.e. Leishmania donovani) and thus should be diagnosed and treated with the utmost urgency to prevent the transmission of the disease. In this study, we tried to report the first instances of corneal complications supposedly associated with Miltefosine (MF), in PKDL patients and the probable pathophysiology of such events. The recently rejuvenated National Kala-azar Elimination Program in Bangladesh has put great emphasis on monitoring all the leishmaniasis patients to investigate possible adverse drug reactions (ADR). A total of 194 patients have received Miltefosine for the treatment of Post Kala-azar Dermal Leishmaniasis. So far five patients were found to have developed unilateral ophthalmic complications during the periods from May 2016 to October 2017, after being treated with MF for PKDL. Unfortunately, one of whom had to go through complete evisceration of the affected eyeball. Despite the fact that MF is the only oral formulation of choice to treat PKDL, occurrences of such unexpected ADRs after MF administration urges the exploration of the pathogenesis of such incidents and determine measures to avert such occurrences from happening in future.
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Affiliation(s)
- Shomik Maruf
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Proggananda Nath
- Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Muhammad Rafiqul Islam
- Department of Ophthalmology, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Fatima Aktar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Azim Anuwarul
- Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Dinesh Mondal
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ariful Basher
- Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
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Basher A, Maruf S, Nath P, Hasnain MG, Mukit MA, Anuwarul A, Aktar F, Nath R, Hossain AFMA, Milton AH, Mondal D, Mohammad Sumsuzzaman AK, Rahman R, Faiz MA. Case Report: Treatment of Widespread Nodular Post kala-Azar Dermal Leishmaniasis with Extended-Dose Liposomal Amphotericin B in Bangladesh: A Series of Four Cases. Am J Trop Med Hyg 2017; 97:1111-1115. [PMID: 28820697 PMCID: PMC5637582 DOI: 10.4269/ajtmh.16-0631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 07/04/2017] [Indexed: 11/07/2022] Open
Abstract
Post kala-azar dermal leishmaniasis (PKDL) is a skin manifestation which usually appears after visceral leishmaniasis. It is now proved that PKDL patients serve as a reservoir for anthropometric leishmanial transmission. Hence, to achieve the kala-azar elimination target set by the World Health Organization in the Indian Subcontinent, PKDL cases should be given priority. The goal of treatment for PKDL should be early reepithelizlization and rapid cure, but unfortunately this has been difficult to achieve, especially for patients with severe lesions. Therefore, we describe here four cases of PKDL who had widespread nodular and macular lesions and were treated with two cycles of LAmB doses with 20 mg/kg body weight divided into four equal doses (each dose contains 5 mg/kg) administered every alternate day. This treatment schedule achieved 100% treatment success with the minimal safety concern.
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Affiliation(s)
- Ariful Basher
- Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Shomik Maruf
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Proggananda Nath
- Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Md Golam Hasnain
- Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle (UoN), New South Wales (NSW), Australia
| | - Muhammod Abdul Mukit
- Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Azim Anuwarul
- Infectious and Tropical Medicine Department, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Fatima Aktar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rupen Nath
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - AFM Akhtar Hossain
- National Kala-azar Elimination Program (NKEP), Directorate General Health Services (DGHS); Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GoB), Dhaka, Bangladesh
| | - Abul Hasnat Milton
- Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle (UoN), New South Wales (NSW), Australia
| | - Dinesh Mondal
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abul Khair Mohammad Sumsuzzaman
- Disease Control Unit, Directorate General Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GoB), Dhaka, Bangladesh
| | - Ridwanur Rahman
- Department of Medicine, Shaheed Suhrawardi Medical College and Hospital (SSMCH), Dhaka, Bangladesh
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